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The United Empire Loyalists’
Association of Canada
50 Baldwin Street, Suite 202, Toronto, Ontario, M5T 1L4 Telephone (416) 591-1783 Fax (416) 591-7506 CERTIFICATE APPLICATION

BRANCH:
_____VICTORIA___________________________________________________________________

BRANCH ADDRESS: _______________________________________________________________
___________________________________________________________________________
Applicant

Name in full.
Maiden Name
Postal Code
E-Mail address
Occupation
Place of Birth
Married at
Husband/Wife
Full Name
Occupation
Place of Birth
Place of Burial
Children
(Names in Full
and Birth
Dates)


Loyalist Ancestor Information
Loyalist Ancestor
Military Service
27 Jan 1784, King’s Rangers, Captain Henry Ruiter’s Company , Corporal (Rank & Regt. If
21 Jan 1783, King’s Rangers quartered at St. Johns, age 28, 6 ft 2in, length of Where Settled
Fredericksburg, Concession IV, lots 5, 6, 7 (date & Location)
2
Applicant Line of Descent From a Loyalist Ancestor
Loyalist Ancestor
Military Service
Roger’s Rangers discharged as corporal, King’s Rangers (rank & regt if known)
Where Settled
(date & Location)
1st Great
2nd Great
3rd Great
4th Great
5th Great
6th Great
8th Great
9th Great
10h Great
2. Father
Residence
Occupation
Death Date
& Place
Daughter of
Occupation
Death Date
& Place
Children
and spouses
if known

Grandparents
3. Father
Residence
Occupation
Death Date
& Place
Daughter of
Occupation
Death Date
& Place
Children
and spouses
if known

1st Great Grandparents
4. Father
Enniskillen, Darlington, Durham, Ontario Married at
Residence
Lot 24, Conc. l7, Darlington, Durham, Ontario Occupation
Death Date
& Place
Daughter of
Occupation
Death Date
& Place
Children
Bertrand Freeman (Helen S. Kennedy), Marcus Howard (Hannah Currie), Gordon Percival, and spouses Dorothy Permila (Ewart S. Sarvis)
if known
2nd Great Grandparents
5. Father
Married at
Residence
Lot 24, Concession VII, Darlington, Durham, Occupation
Bowmanville Cemetery, Darlington, Durham, Death Date
& Place
Daughter of
Occupation
Bowmanville Cemetery, Darlington, Durham, Death Date
& Place
Children
William (Mary Grimston), Mary Dorsey (George Argue), John, Stephen (Julia A. Argue), and spouses Catherine, Hannah (Joseph Cole), Henry, Elizabeth Amanda (Abraham Beacock), Harriet Permillia
if known
(Samuel E. Souch), Thomas Ridley, Mina Adeline (Jabez J. Souch), Norman, Peter, Abraham Lincoln
3rd Great Grandparents
6. Father
Residence
Occupation
Groveside Cemetery, Whitby, Durham, Ontario Death Date
& Place
Daughter of
Occupation
Groveside Cemtery, Whitby, Durham, Ontario Death Date
& Place
Children
Permilia (Thomas Halstead), John Forshee (Susannah Mitts), Elizabeth (John Lammiman), and spouses Mary M. (Erasmus Fowke), Jacob M. (Sarah A. Scott), Daniel, James Addison (Jane Arabella
if known
4th Great Grandparents
7. Father
Residence
Occupation
Death Date
& Place
Daughter of
Occupation
Death Date
& Place
Children
Mary (Thomas Bradley), Elizabeth, Katy, Loisa Jane, John and spouses
if known
5th Great Grandparents
8. Father
Residence
Occupation
Death Date
& Place
Daughter of
Occupation
Death Date
& Place
Nathaniel 21 April 1776, Sarah 7 December 1777, Cornelius 13 April 1779, Joseph 27 March 1780, James 10 February 1782, Deborah 6 August 1783, Archibald 4 January 1786, Elizabeth 10 January Children
and spouses Children by second wife Elizabeth (born 13 April 1770): Clarina 24 October 1790, John Cyrenius 12
if known
December 1791, Cyrenius 14 September 1793, James 27 February 1795, Mary 3 April 1797, Elias 26 October 1798, Daniel 25 October 1800, Charlotte 12 December 1802, Hannah 22 December 1804, David 21 October 1807, Susanna 22 April 1810, Mylo 2 October 1812 6th Great Grandparents
9. Father
Residence
Occupation
Death Date
& Place
Daughter of
Occupation
Death Date
& Place
Children
and spouses
if known
PROOFS OF LINEAL DESCENT
List your direct line of descent, beginning with yourself, one person in each generation to your Loyalist ancestor. Lineal descent is proved by the use of documents which state the relationship of two individuals to each other. The document must state the fac t to be proved: e.g. “William, THE SON of Henry Smith .” Attach copies of your proofs to the back of the application.
1891 census Darlington, West Durham (private) Marriage registry shows Hattie P Bradley dau of Thomas and Permelia to Samuel E. Souch Thomas Halstead’s will lists son James A., dau Permely Halstead Bradley and son-in-law Thomas Bradley Langhorn’s Register: Mary dau of John and Sarah Forsquar 20 Jan 1799, brother James A.’s death certificate shows parents Thomas Halstead and Mary Forshee UCLP showing husband (John Forsyuar) and father Cyrenius Parke UE Loyalist

Source: http://www.uelac.org/Loyalist-Info/extras/Parke-Cyrenius/Parke-Cyrenius-to-Gordon-Wilkinson.pdf

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