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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 Email: uelac@uelac.org 1 CERTIFICATE APPLICATION BRANCH: BRANCH ADDRESS: Applicant Title Name in full. Private Maiden Name Address E-Mail address Married at Husband/Wife Full Name (Names in Full and s) Phone Postal Code Son or Dau of Loyalist Ancestor Information Loyalist Ancestor Military Service (Rank & Regt. If known) Where Settled (date & Location) Ostrom, Roelof (Ruliph, Ruliff, Ralph) Spy for the British

2 Applicant Line of Descent From a Loyalist Ancestor Loyalist Ancestor Ostrom, Roelof Military Service (rank & regt ) Spy for the British Where Settled (date & Location) Born (year) Married (year) Died (year) 2. Parents Private 3. Grand Parents Ostrom, Arthur Danesbury Reney, Letitia Margaret Ann 1864 1871 1894 1930 1907 4. 1 st Great Grand Parents Ostrom, Simeon McKinney, Ann Eliza 1803 1825 1852 1879 1908 5. 2 nd Great Ostrom, Daniel Crysdale, Isabel 1779 1779 1804 1855 1851 6. 3 rd Great Ostrom, Roelof Yelverton, Elizabeth 1740 1742 1761 1818 1817 7. 4 th Great 8. 5 th Great 9. 6 th Great 10. 7 h Great 11. 8 th Great 12. 9 th Great 13. 10 h Great

3 Parents 2. Son of Married at Residence Daughter of and spouses Grandparents 3. Ostrom, Arthur Danesbury Son of Ostrom, Simeon McKinney, Ann E. 4 September 1864 Married at Vancouver, BC 19 September 1894 Residence Vancouver, BC & Sidney Twp, Hastings Co., ON Locomotive Vancouver, BC Engineer 12 August 1930 Vancouver, BC Reney, Letitia Margaret Ann Daughter of Reney, John Occupatio Housewife Thompson, n Brantford, ON 25 February 1871 Vancouver, BC 20 June 1907 Vancouver, BC and spouses

1 st Great Grandparents 4. Ostrom, Simeon Son of Ostrom, Daniel Crysdale, Isabel 23 October 1803 4 Married at Hastings County, ON 2 February 1852 Residence Farmer Ann E. McKinney Daughter of 21 January 1879 Sidney Twp, ON Housewife Kingston, ON 1825 13 October 1908 Hastings Co., ON and spouses 1. Ostrom, Martha 5. Ostrom, Brock 2. Ostrom, Albert 3. Ostrom, Fred 4. Ostrom, Arthur Danesbury m. Reney, Letitia Margaret Ann

5 2 nd Great Grandparents 5. Ostrom, Daniel Son of Ostrom, Roelof Yelverton, Elizabeth Dutchess Co., NY 1 May 1779 Married at 1804 Residence Farmer 1855 Sidney Twp, ON Crysdale, Isabel Daughter of Crysdale, John Housewife??, Rebecca and spouses Charlotte Co., NY 1779 Belleville Cemetery, Sidney Twp, ON Please see attached sheet. 7 March 1851 Hastings Co., ON Generation 5, 2 nd Great Grandparents (p. 4) of Ostrom, Daniel and Crysdale, Isabel 1. Ostrom, Harriet m. White, David 2. Ostrom, Simeon m. (1) Frederick, Lucinda m. (2) McKinney, Ann 3. Ostrom, Isaac Brock m. Grant, Mary 4. Ostrom, Henry m. Foster, Harriett 5. Ostrom, Minerva Jane m. Ketcheson, Elijah 6. Ostrom, Martha (unmarried) 7. Ostrom, Maria m. Herchimer, Joseph 8. Ostrom, Nancy m. Graham, James 9. Ostrom, Sarah Ann m. Ketcheson, Gilbert 10. Ostrom, John Macintosh m. Bonistee, Catherine 11. Ostrom, Daniel m. Bowen, Charlotte

6 3 rd Great Grandparents 6. Ostrom, Roelof Son of Ostrom, Jan Relje, Blandina Poukeepsie, NY 1740 Married at Ulster Co., NY 23 May 1761 Residence Farmer 17 February 1818 Belleville, ON Yelverton, Elizabeth Daughter of Yelverton, Anthony Housewife???, Abigail New York State 1742 1817 Belleville, ON and spouses Please see attached sheet. Generation 6, 3 rd Great Grandparents (p. 5) of Ostrom, Roelof and Yelverton, Elizabeth 12. Ostrom, Henry Anthony m. Hagaman, Sarah 13. Ostrom, John m. Hagaman, Ester 14. Ostrom, Blandina m. Gilbert, Abel 15. Ostrom, Abigail m. Purdy, David 16. Ostrom, Jenna m. Marsh, Samuel 17. Ostrom, Sarah m. Leavens, Roswell 18. Ostrom, Martha m. MacIntosh, John 19. Ostrom, Daniel m. Crysdale, Isabel

7 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 Private 2. Parent Private 3. Grandparent Ostrom, Arthur Danesbury Marriage Registration, BC 4. 1st Great Grandparent Ostrom, Simeon Rev. Robert James McDowall Register of Baptisms for Sidney, ON 5. 2nd Great Grandparent Ostrom, Daniel Upper Canada Land Petition, O Bundle 19. 1835-1836. Library and Archives Canada, 6. 3rd Great Grandparent RG 1, L3, Vol. 395. Ostrom, Roelof Executive Council List, Library and Archives Canada, RG 1, L7, Vol. 52a.