1
The United Empire Loyalists’
Association of Canada
50 Baldwin Street, Suite 202, Toronto, Ontario, M5T 1L4
Telephone (416) 591-1783 Fax (416) 591-7506
Email: [email protected]
CERTIFICATE APPLICATION
BRANCH: __________Victoria, BC__________________________________________________
BRANCH ADDRESS: _______________________________________________________________
___________________________________________________________________________
Applicant
Title
Mrs.
Name in full.
Catherine M Fryer
Date
Maiden Name
Privacy
Phone
Address
Postal Code
E-Mail address
Occupation
14-Feb-2007
Place of Birth
Burnaby, BC
Date
Privacy
Married at
Privacy
Date
Privacy
Husband/Wife
Full Name
Occupation
Privacy
Son or
Dau of
Place of Birth
Privacy
Date
Place of Burial
n/a
Date
Privacy
Privacy
Privacy
Children
(Names in Full
and Birth
Dates)
Loyalist Ancestor Information
Peter Van Camp
Loyalist Ancestor
Military Service
(Rank & Regt. If
known)
Where Settled
(date & Location)
Private, Loyal Rangers
Died in Montreal, QC in 1783, put on UE List posthumously by his son, Jacob
Van Camp. Daughter, Jenny Miller, settled 1790, Township of Ernestown,
Midland District, Ontario
2
Applicant Line of Descent From a Loyalist Ancestor
Peter Van Camp
Loyalist Ancestor
2.
3.
4.
Military Service
(rank & regt if known)
Where Settled
(date & Location)
Father
Parents
Mother
Grand
Father
Parents
Mother
1st Great
Father
Grand
Parents
5.
2nd Great
Grand
Parents
6.
3rd Great
Grand
Parents
7.
4th Great
Grand
Parents
8.
5th Great
Grand
Parents
th
9.
6 Great
Grand
Parents
10.
7h Great
Grand
Parents
11.
8th Great
Grand
Parents
12.
9th Great
Grand
Parents
h
13.
10 Great
Grand
Parents
Mother
Father
Mother
Father
Mother
Father
Mother
Father
Mother
Father
Mother
Father
Mother
Father
Mother
Father
Mother
Father
Mother
Private, Loyal Rangers
Married
1790 Township of Ernestown, Midland District,
ON
Privacy
Privacy
Born
(year)
Forbes, Raymond Alexander
Jaynes, Ida Lorena
1904
1912
1932
1994
2004
Jaynes, George Earl
Weese, Margaret Eliza
1886
1888
1906
1984
1976
Weese, Samuel David
Miller, Nancy Alida
1860
1867
1885
1896
1949
Miller, Norris Brisco
Aylesworth, Margaret Nancy
1829
1829
1866
1912
1913
Miller, Peter
Brisco, Esther
1792
1803
Abt
1826
1868
1859
Miller, Andrew
Van Camp, Jane (Jenny)
1757
1760
1784
1828
1827
Van Camp, Peter
Bergen, Femmetje (Phebe)
1721
1750
1783
Privacy
(year)
Privacy
Died
(year)
3
2.
Parents
Father
Privacy
Son of
Privacy
Place of
Birth
Married
at
Residence
Kindersley, SK
Date
Privacy
Cloverdale, BC
Date
Privacy
Occupation
Privacy
Place of
Burial
Mother
n/a
Death Date
& Place
Daughter of
n/a
Date
Privacy
Death Date
& Place
n/a
Son of
Privacy
Privacy
Occupation
Humboldt, SK
Place of
Birth
n/a
Place of
Burial
Privacy
Children
and spouses
if known
3.
Grandparents
Forbes, Raymond Alexander
Father
Place of
Birth
Married
at
Residence
Murray Harbour, PE
Date
John Spurgeon
Forbes
25 – Apr – 1904
Flaxcombe, SK
Date
5 – Jul – 1932
Occupation
Carpenter
Place of
Burial
Mother
Surrey Centre, BC
Death Date
& Place
Daughter of
1994
Cloverdale, BC
Date
5 – Aug – 1912
Death Date
& Place
1 – Feb – 2004
Cloverdale, BC
Jaynes, Ida Lorena
Margaret Eliza
Weese
Occupation
Richmond, Lennox & Addington, ON
Place of
Birth
Surrey Centre, BC
Place of
Burial
Privacy
Children
and spouses
if known
4
st
4.
1 Great Grandparents
Jaynes, George Earl
Father
Son of
Place of
Birth
Adolphstown, Lennox & Addington, ON
Date
3 – Jun – 1886
Married at
Morven, ON
Date
27 – Jun – 1906
Residence
Occupation
Farmer
Place of
Burial
Mother
Weese, Margaret Eliza
Death Date
& Place
Daughter of
6 – Feb – 1884
Cloverdale, BC
Samuel David
Weese
Occupation
Housekeeper
Date
24 – Oct – 1888
Death Date
& Place
9 – Mar – 1976
Cloverdale, BC
Place of
Birth
Place of
Burial
Children
and spouses
if known
Nr Bath, Lennox & Addington, ON
Mary Alida, Ida Lorena, Privacy, George Earl, Margaret
nd
5.
2 Great Grandparents
Weese, Samuel David
Father
Place of
Birth
Married at
Son of
Stephen Weese
Ernestown, Lennox & Addington, ON
Date
5 – Jul – 1860
Ernestown, Lennox & Addington, ON
Date
6 – Nov – 1885
Occupation
Farmer
Miller, Nancy Alida
Death Date
& Place
Daughter of
20 – Dec – 1896
Kingston, ON
Norris Brisco
Miller
Bath, ON
Date
26 – Jul – 1867
Bath Cemetery, Ernestown, ON
Death Date
& Place
7 – Jul – 1949
Kingston, ON
Residence
Place of
Burial
Mother
Bath Cemetery, Ernestown, ON
Occupation
Place of
Birth
Place of
Burial
Children
and spouses
if known
William Henry, Etta May, Margaret Eliza, Steven David, Caroline Victoria, Benjamin Samuel, Frederick
Norris
5
6.
3rd Great Grandparents
Miller, Norris Brisco
Father
Place of
Birth
Married
at
Residence
Place of
Burial
Mother
Son of
Peter Miller
Ernestown, Lennox & Addington, ON
Date
28-Mar-1829
Ernestown, ON
Date
1-Mar-1866
Occupation
Farmer
Death Date
& Place
Daughter of
17-Aug-1911
Ernestown, ON
David Aylesworth
Date
12-May-1829
Death Date
& Place
23-Aug-1914
Son of
Andrew Miller
Date
Bap 7-Oct-1792
Date
Abt 1826
Occupation
Farmer
1868
Brisco, Esther
Death Date
& Place
Daughter of
Ernestown, ON
Date
Bap 21-Aug-1803
Aylesworth, Margaret Nancy
Occupation
Ernestown, ON
Place of
Birth
Place of
Burial
Nancy Alida, Benjamin, Esther Elizabeth
Children
and spouses
if known
7.
4th Great Grandparents
Miller, Peter
Father
Place of
Birth
Married
at
Residence
Ernestown, ON
Place of
Burial
Mother
Bath Anglican Cemetery, Bath, ON
Norris Brisco
Occupation
Place of
Birth
1859
Death Date
Bath Anglican Cemetery, Bath, ON
Place of
& Place
Burial
Andrew, Norris Brisco, John Benjamin, Elizabeth Anne, Jane Margaret, Nathan Anuten,
Children
and spouses Albert Anson, Ruth Eliza, Peter Van Camp
if known
6
8.
5th Great Grandparents
Miller, Andrew
Father
Son of
Andreas Muller
Date
Bap 29-May-1757
Date
14-Nov-1784
Occupation
Farmer
Dec-1828
Van Camp, Jane (Jenny)
Death Date
& Place
Daughter of
New York, USA
Date
15-Nov-1760
Bath Anglican Cemetery, Bath, ON
Death Date
& Place
May-1827
Place of
Birth
Married
at
Residence
Reformed Germantown, New York, USA
Place of
Burial
Mother
Bath Anglican Cemetery, Bath, ON
Peter Van Camp
Occupation
Place of
Birth
Place of
Burial
Children
and spouses
if known
9.
Andrew, Jacob, John m Rachel Hawley, Margaret, Peter, William A m Alida Sharp, Samuel
m Amanda Hawley, Ann (Nancy) m Frederick Keller
6th Great Grandparents
Van Camp, Peter
Father
Place of
Birth
Married
at
Residence
Place of
Burial
Mother
Kingston, NY, USA
Son of
Jacob Van Campen
Date
1721
Date
1750
Occupation
Bergen, Femmetje (Phebe)
Death Date
& Place
Daughter of
1783, Montreal, QC
Occupation
Place of
Birth
Date
Death Date
Place of
& Place
Burial
Mary
m
Johannes
Buys,
Phoebe
m
Samuel
Streit,
Simon
m
Sara
Buys, Jacob m Annetje Buys, Teunis
Children
and spouses m Elizabeth LaGrange, Jenny m Andrew Miller, Heletje m William Leahy Jr, Johannes m Mary
Freeze, Sara, Peter
if known
9
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 fact to be
proved: e.g. “William, THE SON of Henry Smith ...”
Attach copies of your proofs to the back of the application.
1. Applicant
Proof
2. Parent
Proof
3. Grandparent
Proof
4. 1st Great
Grandparent
Proof
nd
Catherine M Fryer
Birth Certificate with parents
Privacy
Birth Certificate with parents
Ida Lorena Jaynes
Birth Certificate with parents
Margaret Eliza Weese
Birth Certificate with parents
5. 2 Great
Grandparent
Proof
Nancy Alida Miller
6. 3rd Great
Grandparent
Proof
Norris Brisco Miller
7. 4th Great
Grandparent
Proof
Peter Miller
th
Marriage Certificate
Marriage Record with parents named
Baptism, UEL Petition – Recommended
8. 5 Great
Grandparent
Proof
Jane (Jenny) Van Camp
9. 6th Great
Grandparent
Proof
Peter Van Camp
10. 7rd Great
Grandparent
Proof
11. 8th Great
Grandparent
Proof
12. 9th Great
Grandparent
Proof
13. 10th Great
Grandparent
Proof
UEL Petition – Certificate Granted