Application for Enrolment as an
Algonquin Elector
IMPORTANT NOTE
If you have previously submitted an application to your
community leader, then it is not necessary to complete a
new application. However, if your address has changed
since you submitted your application, please submit the
Change of Address notification attached to this form.
1
Instructions for completing this application are attached.
Please print in block (SAMPLE) letters using black or blue ink.
You must be 18 years of age or older to complete this application.
Personal Information
Last Name
First Name
Middle Name (s)
Maiden Name (if applicable)
Surname at Birth (if different than your current surname)
Date of Birth (day/month/yr)
Place of Birth
_____________________________________
City/Town
Sex
Female
Marital Status
Male
Single
Common Law
Married
________
Province
_____________________
Country
Separated
Divorced
_________
Postal Code
Widowed
Permanent Address
Number
Street
Apartment
City
Apartment
City
Province/Territory
Postal Code
Mailing Address (if different from above)
Number
Street
Home Telephone Number
(
)
2
Work Telephone Number
(
)
Province/Territory
Fax Number (optional)
(
)
Postal Code
E-Mail Address (optional)
Spouse's Personal Information
Important: Your spouse must complete a separate application in order to be enrolled .
Spouse's Full Name (if applicable)
Last Name
Date of Birth (day/month/year)
First Name
Place of Birth
_________________________________
City/Town
Date of Marriage (day/month/year)
Middle Name(s)
______________
Province
__________________
Country
______________
Province
__________________
Country
Place of Marriage
_________________________________
City/Town
Page 1
3
Membership Information
IMPORTANT: If you are a status Indian, please attach a photocopy of both sides of your status card.
Applicant - (Place an x in the appropriate boxes)
Spouse -
(Place an x in the appropriate boxes)
1. Non-Registered/Non-Status
1. Non-Registered/Non-Status
2. Registered/Status Indian
2. Registered/Status Indian
3. Recognized Band Member
3. Recognized Band Member
Band Name:_________________________________
Band Name:_________________________________
Province :___________________________________
Province :___________________________________
Please see item #2 on page 2 of the "Instructions" for important information on definitions.
Representation
4
Please indicate which community of Algonquins you are affiliated with: (see below)
Sharbot Lake
Antoine
Mattawa/North Bay
Bonnechere
Greater Golden Lake
Bancroft
Ardoch
Whitney
Other (please specify) _______________________
Family Information
5
Important: Children who are 18 years and older should complete a separate application.
Names of your Children
Date of Birth (day/month/year)
Place of Birth
1. ___________________________________________
_________________________
____________________________
2. __________________________________________
_________________________
____________________________
3. __________________________________________
_________________________
____________________________
4. __________________________________________
_________________________
____________________________
5. ___________________________________________
_________________________
____________________________
6. ___________________________________________
_________________________
____________________________
7. ___________________________________________
_________________________
____________________________
8. ___________________________________________
_________________________
____________________________
9. ___________________________________________
_________________________
____________________________
10. __________________________________________
_________________________
____________________________
Page 3
Page 2
Ancestry
6
IMPORTANT: Please complete ancestry chart(s) attached to this application (pages 4 & 5)
If known, please indicate the name(s) of the person(s) on Schedule "A" who is your ancestor.
1. ____________________________________ 3. _________________________________________
2. ____________________________________ 4. _________________________________________
Please indicate which supporting documents you have attached to this application: (You must include originals for official documents)
Extended Birth Certificate
Statutory Declaration
Baptismal Certificate
Affidavits
Divorce Decree
Marriage Record
Census Records
Death Certificate
Military Records
Status card (both sides)
Legal change of name
7
Adoption Record
Separation Papers
Other Documents (Please specify):
________________________________________
Authorization
I hereby authorize the Enrolment Officer to contact persons and/or organizations named in this form and its attachments, or as they require to
verify information for the purpose of evaluating my application for enrolment.
I hereby declare that the information is accurate and true to the best of my knowledge.
______________________________________________________________
(Applicant's Signature)
8
________________________________
Date Signed: (day/month/year)
For Office Use Only (DO NOT write in this space)
Date R'cd: _________________________
Date app. postmarked: ______________________________
Application # _______________________
Manual File ID: _____________________________________
Page 3
Page 3
ANCESTRY CHART
Your Parents
Your Grandparents
Your Great Grandparents
CONT'D on p. 6
8. Your Father's Father Father:
See 16 & 17
Birth date and place:
Marriage date and place:
4. Your Father's Father:
Death date and location:
9. Your Father's Father's Mother:
Birth date:
See 18 & 19
Birth place:
Birth date and place:
Marriage date:
Death date and location:
Marriage location:
Death Date:
2. Your Father:
10. Your Father's Mother's Father:
Death location:
See 20 & 21
Birth date and place:
Birth date:
5. Your Father's Mother:
Birth place:
1. You:
Death date and location:
Marriage date:
Birth date:
Marriage location:
Birth place:
Death Date:
Death Date:
Birth date and place:
Death location:
Death location:
Death date and location:
6. Your Mother's Father:
12. Your Mother's Father's Father:
Birth date:
Birth date and place:
Birth date:
Birth place:
11. Your Father's Mother's Mother:
See 22 & 23
See 24 & 25
Marriage date:
3. Your Mother:
Marriage location:
Your Spouse:
Birth place:
Marriage date and place:
Marriage date:
Death date and location:
Marriage location:
13. Your Mother's Father's Mother:
Birth date:
Death Date:
Birth place:
Death location:
Death Date:
Birth date:
Death location:
See 26 & 27
Birth date and place:
Death date and location:
7. Your Mother's Mother
Birth place:
Death Date:
14. Your Mother's Mother's Father:
See 28 & 29
Death location:
Instructions
Names:
Marriage date and place:
Birth date:
Birth date and place:
Birth place:
Marriage date and place:
Death Date:
Death date and location:
Death location:
15. Your Mother's Mother's Mother:
FIRST MIDDLE LAST
Dates:
DAY MONTH YEAR
Locations: CITY/TOWN, PROVINCE
Page 4
Circle or otherwise indicate the name of any person
on this chart who appears on the Schedule A
list of Algonquin Ancestors
See 30 & 31
Birth date and place:
Death date and location:
Ancestry Chart, continued
PATERNAL
(Your Father's Side)
See page 5 for previous generations
Your Great Great Grandparents
16. Your Father's Father's Father's Father:
Birth date and place:
Parents of 8.
Marriage date and place:
Death date and location:
17. Your Father's Father's Father's Mother:
Birth date and place:
Death date and location:
18. Your Father's Father's Mother's Father:
Birth date and place:
Parents of 9.
Marriage date and place:
Death date and location:
MATERNAL
(Your Mother's Side)
Your Great Great Grandparents
19. Your Father's Father's Mother's Mother:
Birth date and place:
Death date and location:
20. Your Father's Mother's Father's Father:
24. Your Mother's Father's Father's Father
Birth date and place:
Birth date and place:
Parents of 10. Marriage date and place:
Death date and location:
Marriage date and place:
Parents of 12.
Death date and location:
21. Your Father's Mother's Father's Mother:
25. Your Mother's Father's Father's Mother
Birth date and place:
Death date and location:
Birth date and place:
Death date and location:
22. Your Father's Mother's Mother's Father:
26. Your Mother's Father's Mother's Father
Birth date and place:
Birth date and place:
Parents of 11. Marriage date and place:
Death date and location:
Marriage date and place:
Parents of 13.
Death date and location:
23. Your Father's Mother's Mother's Mother:
27. Your Mother's Father's Mother's Mother
Birth date and place:
Death date and location:
Birth date and place:
Death date and location:
28. Your Mother's Mother's Father's Father
Birth date and place:
Marriage date and place:
Parents of 14.
Death date and location:
29. Your Mother's Mother's Father's Mother
Birth date and place:
Instructions
Death date and location:
Names: FIRST MIDDLE LAST
30. Your Mother's Mother's Mother's Father
Dates: DAY MONTH YEAR
Locations: CITY/TOWN, PROVINCE
Circle or otherwise indicate the name of any person on this chart
who appears on Schedule A list of Algonquin ancestors
Birth date and place:
Marriage date and place:
Parents of 15.
Death date and location:
31. Your Mother's Mother's Mother's Mother
If you have information on earlier generations of your
ancestry, please attach it to your application
Birth date and place:
Death date and location:
Page 5
General Information and Instructions for Completion of the
Application for Enrolment as an Algonquin Elector
GENERAL INFORMATION
•
Please print clearly in block letters (ALL CAPS).
•
You must be 18 years of age or older in order to complete an application.
•
See Appendix B for details regarding the criteria for enrolment as an Elector.
HOW TO SUBMIT YOUR APPLICATION
Your application along with supporting documents must be mailed or couriered to the
following address:
c/o Enrolment Officer
Joan Holmes & Associates Inc.
7 Hinton Ave North, Suite 200
Ottawa, Ontario K1Y 4P1
TELEPHONE INQUIRIES
If you have questions about filling out the application please contact: 1-877-287-4570. This
toll-free number will be operational as of Friday, September 17, 2004.
CHECKLIST
All 5 pages of the application form completed and SIGNED at page 3 as indicated.
Supporting documentation including ORIGINALS of official documents (see page 3 for more
information). Failure to meet supporting document requirements may result in refusal of your
application for enrolment.
PERSONAL INFORMATION
Personal information provided on your application form is intended to be used for the purpose
of the election of Algonquin Negotiation Representatives and will also be added to a database for
future communications regarding negotiations. The information provided may be verified by the
Enrolment Officer.
General Information and Instructions for Completion of Application for Enrolment as an Algonquin Elector
Page 1
INSTRUCTIONS
n
PERSONAL INFORMATION.
Please insert your surname (last name) at birth in the space provided if different
than your current surname.
o SPOUSE’S PERSONAL INFORMATION
Your spouse must apply separately if he/she wishes to be enrolled.
p MEMBERSHIP INFORMATION
Place an x in a box for any and all options which apply to you.
1. Non-Registered/Non-Status. Check this box if you are a person of
Aboriginal descent who is not registered as an Indian under the Indian Act.
(see 4 below to indicate your community of representation)
2. Registered/Status Indian. Check this box if you are a registered Indian
under the Indian Act, e.g. recognized by the government of Canada’s
Indian and Northern Affairs. Please supply a copy of your status card
(both sides).
3. Recognized Band Member. Check this box if you are a member of a
status Indian band under the Indian Act. Please name the band in the
space provided.
q REPRESENTATION
Under the Addendum, an Algonquin Negotiation Representative will be elected
from each community of Algonquins with a minimum membership of 125 persons
of Algonquin descent. Each applicant for enrolment must select in which
community he/she has past or present residency or social or family ties. This will
be the community in which the applicant will vote. Please check off one of the
communities listed or write in another community (in the space provided) which
satisfies the criteria set out in the Addendum at paragraph 2 (i).
See http://www.blaney.com/algonquin.htm for the text of the Addendum.
General Information and Instructions for Completion of Application for Enrolment as an Algonquin Elector
Page 2
r FAMILY INFORMATION
List each of your children in the space provided. If there is insufficient space
provided, please append an additional sheet to your application. Children who
are over the age of 18 should submit their own application for enrolment.
s ANCESTRY
Information on your ancestry should be provided in the ancestry chart on pages
4 and 5 of your Application. According to the enrolment criteria (see Appendix B)
you must be a direct lineal descendant of a person on Schedule A, or a
descendant of an Algonquin previously accepted by the Enrolment Board. You
may view Schedule A online at http://www.blaney.com/algonquin.htm (click on
"Addendum to Protocol Agreement.pdf", see pages 25 to 58). Copies are also
available by mail from the Enrolment Officer or by calling the toll-free number 1877-287-4570 after September 17, 2004.
Supporting documentation. Originals of official documents must be provided.
THEY WILL BE KEPT SAFE AND SECURE AND WILL BE RETURNED TO
YOU AFTER REVIEW TO THE MAILING ADDRESS YOU PROVIDE. Note: If
you do not wish to supply originals, then you have two alternatives:
1. supply notarized photocopy of original; or
2. present originals for viewing to Joan Holmes and Associates Inc.
It is not necessary to supply originals of unofficial documentation, for example
genealogical charts or census data. The following is a list of official documents:
•
•
•
•
•
•
•
•
•
•
Extended Birth Certificate
Baptismal Certificate
Marriage Record
Death Certificate
Statutory Declaration
Adoption Record
Affidavits
Legal change of Name
Divorce Decree
Separation Papers
See Appendix A on page 4 for assistance in obtaining genealogical data and
official documentation.
t AUTHORIZATION
Please sign and date the application at page 3.
General Information and Instructions for Completion of Application for Enrolment as an Algonquin Elector
Page 3
APPENDIX A
GENEALOGICAL INFORMATION
Important: You may wish to contact your community leader or other official for
advice or assistance in obtaining vital records.
1. Obtaining Birth, Marriage and Death Records for Events which occurred in Ontario
a) Application forms for Ontario birth certificates are available:
• online http://www.cbs.gov.on.ca/mcbs/english/4U4V5Z.htm
• by mail from the Office of the Registrar General Box 4600, Thunder Bay
Ontario, P7B 6L8 Tel: 416-325-8305 1-800-461-2156 (toll-free in Ontario)
• in person from the Toronto Office at 900 Bay Street, 2nd floor; and
• at Ontario Land Registry Offices and Government Information Centres provincewide
b) Processing Times for Obtaining Documents from Registrar General of Ontario
Regular service currently requires a minimum of 6-8 weeks.
c) Delivery: All certificates will be delivered to the address provided on the application
form.
The Archives of Ontario holds birth registrations for the years 1869 to 1907 (1908
registrations will be opened in 2005), marriages 1780 to 1922 (but prior to 1869, these
records are very incomplete), 1869 to 1932. Information can be found on their website
located at: http://www.archives.gov.on.ca/english/interloan/vsmain.htm
Some local libraries also have microfilm copies of indexes to these vital statistics.
2. Obtaining Birth, Marriage and Death Records for Events which occurred in Other
Provinces and Territories
The National Archives of Canada's website has information on how you may obtain vital
records from other provinces. Their internet address is:
http://www.genealogy.gc.ca/10/100606_e.html
3. Genealogical Research Resources
There is a great deal of information available on the internet about how to research family
history and genealogy.
General Information and Instructions for Completion of Application for Enrolment as an Algonquin Elector
Page 4
Good starting points are:
1. The Archives of Ontario’s Genealogical Research Site:
http://www.archives.gov.on.ca/english/geneal/index.html
2. The Library and Archives Canada’s Canadian Genealogy Centre:
http://www.genealogy.gc.ca
3. The Latter Day Saints family search web site has information on conducting
genealogical research in international locations. www.familysearch.org
4. Cyndi's List – This is an index to a variety of international genealogical topics
including areas relating to Canadian and Native American genealogy.
http://www.cyndislist.com/
5. Census Records Online: There are a number of online resources that will help you
quickly locate appropriate census records. These are as follows:
a) 1871 Ontario Census Index - http://www.lac-bac.gc.ca/archivianet/020108_e.html
b) 1881 Census of Canada - www.familysearch.org/Eng/Search/frameset_search.asp
c) 1901 Fourth Census of Canada - www.lac-bac.gc.ca/archivianet/020122_e.html
The 1901 census is not indexed. Automated Genealogy's website has partially
indexed these records. The website is:
http://automatedgenealogy.com/census/NationalSummary.jsp
General Information and Instructions for Completion of Application for Enrolment as an Algonquin Elector
Page 5
APPENDIX B
Criteria for enrolment as an Elector
Criteria for enrolment as per Addendum to the March 25, 2004 Protocol Agreement. See
the full text in section II.10 at http://www.blaney.com/algonquin.htm: The following is an
extract from the Addendum.
“II. The Electors
10. Persons who declare themselves Algonquin and who meet the following criteria shall
be added to the Electors’ List (described below) and thereby shall be entitled to vote in
the elections for the position of Algonquin Negotiation Representative referred to in
paragraph 2.
Persons who:
(a) have attained the age of 18 years on or before October 1, 2004; and
(b) who were enrolled on or before November 17, 2001 on the list maintained for that
purpose pursuant to the then existing Algonquin Enrolment Law, May 31, 1994 (the
“List”) provided there is no adverse determination made in that regard by the Enrolment
Officer as a result of the review undertaken by him or her pursuant to paragraph 14 (a); or
(c) subject to the review described in paragraph 14 (a), were added to the List after
November 17, 2001; or
(d) can demonstrate direct lineal descent from at least one person identified in
Schedule “A” annexed to the then existing Algonquin Enrolment Law, May 31, 1994
(A further copy of Schedule “A” is annexed as Appendix C) ; or
(e) can demonstrate direct lineal descent from at least one person previously
accepted as an Algonquin by the Enrolment Board established pursuant to the then
existing Algonquin Enrolment Law, May 31, 1994.” [emphasis added]
General Information and Instructions for Completion of Application for Enrolment as an Algonquin Elector
Page 6
Appendix C - Change of Address Notification
"
Change of Address Notification
Please complete this Change of Address Card only if your address has changed
in the period since you submitted your application.
First Name ______________________ Last Name ________________________ Middle Name________________
Date of Birth (day/month/year) __________________________________________________________
Address
__________
_______________
______________
________________ ___________ ________
Street Number
Apartment Number
Street Name
City/Town
Telephone Number: (
) ________ - ____________
ANSIC-AppFormSept04
Postal Code
E-Mail Address: __________________________________
__________________________________________
Signature
Please mail this card to:
Province
__________________________
Date
c/o Enrolment Officer
Joan Holmes & Associates Inc.
7 Hinton Avenue North, Suite 200
Ottawa, ON K1Y 4P1