Personal Information. Single Common Law Married Separated Divorced Widowed. Number Street Apartment City Province/Territory Postal Code

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1 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. Application for Enrolment as an Algonquin Elector 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. 1 Last Name Personal Information 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 Sex Female City/Town Province Country Postal Code Marital Status Male Permanent Address Single Common Law Married Separated Divorced Widowed Number Street Apartment City Province/Territory Postal Code Mailing Address (if different from above) Number Street Apartment City Province/Territory Postal Code Home Telephone Number ( ) 2 Work Telephone Number ( ) Fax Number (optional) ( ) Spouse's Personal Information Important: Your spouse must complete a separate application in order to be enrolled. Spouse's Full Name (if applicable) Address (optional) Last Name First Name Middle Name(s) Date of Birth (day/month/year) Place of Birth Date of Marriage (day/month/year) City/Town Province Country Place of Marriage City/Town Province Country Page 1

2 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) 1. Non-Registered/Non-Status 2. Registered/Status Indian 3. Recognized Band Member Spouse - (Place an x in the appropriate boxes) 1. Non-Registered/Non-Status 2. Registered/Status Indian 3. Recognized Band Member Band Name: Province : Band Name: Province : Please see item #2 on page 2 of the "Instructions" for important information on definitions. 4 Representation Please indicate which community of Algonquins you are affiliated with: (see below) Sharbot Lake Mattawa/North Bay Greater Golden Lake Ardoch Antoine Bonnechere Bancroft Whitney Other (please specify) 5 Family Information 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 Page 3 Page 2

3 6 Ancestry 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 Please indicate which supporting documents you have attached to this application: (You must include originals for official documents) Extended Birth Certificate Statutory Declaration Adoption Record Baptismal Certificate Affidavits Divorce Decree Marriage Record Census Records Separation Papers Death Certificate Military Records Other Documents (Please specify): Status card (both sides) Legal change of name 7 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) Date Signed: (day/month/year) 8 For Office Use Only (DO NOT write in this space) Date R'cd: Application # Date app. postmarked: Manual File ID: Page 3 Page 3

4 ANCESTRY CHART Your Parents Your Grandparents Your Great Grandparents CONT'D on p Your Father's Father Father: Marriage date and place: 4. Your Father's Father: 9. Your Father's Father's Mother: Birth date: See 18 & 19 Birth place: Marriage date: Marriage location: Death Date: 10. Your Father's Mother's Father: 2. Your Father: Death location: See 20 & 21 Birth date: 5. Your Father's Mother: Marriage date and place: Birth place: Marriage date: Birth date: 11. Your Father's Mother's Mother: Marriage location: Birth place: See 22 & 23 Death Date: Death Date: 1. You: Death location: Death location: See 16 & Your Mother's Father: 12. Your Mother's Father's Father: Birth date: See 24 & 25 Birth place: Birth date: Marriage date: 3. Your Mother: Birth place: Marriage date and place: Marriage location: Marriage date: Marriage location: 13. Your Mother's Father's Mother: Birth date: Death Date: See 26 & 27 Your Spouse: Birth place: Death location: Death Date: Birth date: Death location: 7. Your Mother's Mother Birth place: 14. Your Mother's Mother's Father: Death Date: See 28 & 29 Death location: Birth date: Birth place: Marriage date and place: Instructions Death Date: Death location: 15. Your Mother's Mother's Mother: Page 4 Names: FIRST MIDDLE LAST See 30 & 31 Dates: DAY MONTH YEAR Locations: CITY/TOWN, PROVINCE Circle or otherwise indicate the name of any person on this chart who appears on the Schedule A list of Algonquin Ancestors

5 Ancestry Chart, continued PATERNAL (Your Father's Side) Your Great Great Grandparents See page 5 for previous generations Parents of 8. Parents of Your Father's Father's Father's Father: Marriage date and place: 17. Your Father's Father's Father's Mother: 18. Your Father's Father's Mother's Father: Marriage date and place: 19. Your Father's Father's Mother's Mother: MATERNAL (Your Mother's Side) Your Great Great Grandparents 20. Your Father's Mother's Father's Father: 24. Your Mother's Father's Father's Father Parents of 10. Marriage date and place: Marriage date and place: Parents of Your Father's Mother's Father's Mother: 25. Your Mother's Father's Father's Mother 22. Your Father's Mother's Mother's Father: 26. Your Mother's Father's Mother's Father Parents of 11. Marriage date and place: Marriage date and place: Parents of Your Father's Mother's Mother's Mother: 27. Your Mother's Father's Mother's Mother 28. Your Mother's Mother's Father's Father Parents of 14. Marriage date and place: 29. Your Mother's Mother's Father's Mother Instructions 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 Marriage date and place: who appears on Schedule A list of Algonquin ancestors Parents of Your Mother's Mother's Mother's Mother If you have information on earlier generations of your ancestry, please attach it to your application Page 5

6 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: This toll-free number will be operational as of Friday, September 17, 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

7 INSTRUCTIONS PERSONAL INFORMATION. Please insert your surname (last name) at birth in the space provided if different than your current surname. SPOUSE S PERSONAL INFORMATION Your spouse must apply separately if he/she wishes to be enrolled. 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. 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 for the text of the Addendum. General Information and Instructions for Completion of Application for Enrolment as an Algonquin Elector Page 2

8 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. 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 (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 after September 17, 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. 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

9 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 by mail from the Office of the Registrar General Box 4600, Thunder Bay Ontario, P7B 6L8 Tel: (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 Information can be found on their website located at: 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: 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

10 Good starting points are: 1. The Archives of Ontario s Genealogical Research Site: 2. The Library and Archives Canada s Canadian Genealogy Centre: 3. The Latter Day Saints family search web site has information on conducting genealogical research in international locations Cyndi's List This is an index to a variety of international genealogical topics including areas relating to Canadian and Native American genealogy 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 - b) 1881 Census of Canada - c) 1901 Fourth Census of Canada - The 1901 census is not indexed. Automated Genealogy's website has partially indexed these records. The website is: General Information and Instructions for Completion of Application for Enrolment as an Algonquin Elector Page 5

11 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 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, [emphasis added] General Information and Instructions for Completion of Application for Enrolment as an Algonquin Elector Page 6

12 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 Province Postal Code Telephone Number: ( ) - Address: Signature Date Please mail this card to: c/o Enrolment Officer Joan Holmes & Associates Inc. 7 Hinton Avenue North, Suite 200 Ottawa, ON K1Y 4P1 ANSIC-AppFormSept04