APPLICATION FOR
CERTIFICATE OF TENNESSEE
ANCESTRY
(PLEASE TYPE OR PRINT ALL DATA)
Direct lineal descent from Generation 1 
to applicant.  Enclose as much additional information or extra sheets as needed.
_________________________________ 
Name of applicant, as it is to appear on certificate

Address:__________________________________

City:_____________________________________

State:_________________  Zip:_____________

Phone number: ____________________________



GENERATION 1 - Relationship to Applicant ___________________________________________

Name of Tennessee Ancestor from whom you claim descent (this will be the Ancestor whose name appears on certificate.)
 

________________________________________________________________________________________________________________________
Last Name                                         First                          Middle
 

Date of Birth: ______________________________ Place of Birth: __________________________________________________________
                Day - Month - Year                              Town/County/State/Other

Date Died: __________________________________ Place of Death: __________________________________________________________
               Day - Month - Year                               Town/County/State/Other

Place Buried: __________________________________________________________________________________________________________
                 Name of Cemetery (if known)   Town/County/State

Father's Name (if known) ___________________________________________ Place of Birth:_____________________________________
 

Mother's Name (if known) ___________________________________________ Place of Birth:_____________________________________

Dates and places lived in Tennessee (including earliest date for which documentation is enclosed.
This date will show on certificate):
 

_________________________________________________________________________________________________________________________

Name of spouse of ancestor (and marriage data if known):
 

________________________________________________________________ Son/Dau of:_____________________________________________
 Last Name (Maiden name if female)  First   Middle

Date Married:______________________________________ Place Married: ______________________________________________________
                Day - Month - Year                                  Town/County/State/Other

If not first marriage, indicate other marriage data: ____________________________________________________________________

Children: (List your direct ancestor first.  Additional names/data may be listed on extra sheet.)
NAME              BORN-DATE-PLACE         DIED-DATE-PLACE        MARRIED TO

_________________________________________________________________________________________________________________________
 

_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________

List documented proof attached. (If printed sources, show Title, Author, Page No.)
 
 
 


GENERATION 2 - Relationship to Applicant: _________________________________________________________________________

________________________________________________________________________________________________________________________
Last Name                                         First                          Middle
 

Date of Birth: ______________________________ Where: ___________________________________________________________________
                Day - Month - Year                              Town/County/State/Other

Date Died: __________________________________ Where: ___________________________________________________________________
                Day - Month - Year                              Town/County/State/Other

Date Married ________________________________ Where: ___________________________________________________________________
                Day - Month - Year                              Town/County/State/Other

Spouse's Name:__________________________________________ Son/Dau of:____________________________________________________
               Last           First     Middle

List children, if known, on separate page:
Proof enclosed.
 



GENERATION 3 - Relationship to Applicant: _________________________________________________________________________

________________________________________________________________________________________________________________________
Last Name                                         First                          Middle
 

Date of Birth: ______________________________ Where: ___________________________________________________________________
                Day - Month - Year                              Town/County/State/Other

Date Died: __________________________________ Where: ___________________________________________________________________
                Day - Month - Year                              Town/County/State/Other

Date Married ________________________________ Where: ___________________________________________________________________
                Day - Month - Year                              Town/County/State/Other

Spouse's Name:__________________________________________ Son/Dau of:____________________________________________________
               Last           First     Middle

List children, if known, on separate page:
Proof enclosed.


GENERATION 4 - Relationship to Applicant: _________________________________________________________________________

________________________________________________________________________________________________________________________
Last Name                                         First                          Middle
 

Date of Birth: ______________________________ Where: ___________________________________________________________________
                Day - Month - Year                              Town/County/State/Other

Date Died: __________________________________ Where: ___________________________________________________________________
               Day - Month - Year                              Town/County/State/Other

Date Married ________________________________ Where: ___________________________________________________________________
                Day - Month - Year                              Town/County/State/Other

Spouse's Name:__________________________________________ Son/Dau of:____________________________________________________
               Last           First     Middle

List children, if known, on separate page:
Proof enclosed.



GENERATION 5 - Relationship to Applicant: _________________________________________________________________________

________________________________________________________________________________________________________________________
Last Name                                         First                          Middle
 

Date of Birth: ______________________________ Where: ___________________________________________________________________
                Day - Month - Year                              Town/County/State/Other

Date Died: __________________________________ Where: ___________________________________________________________________
                Day - Month - Year                              Town/County/State/Other

Date Married ________________________________ Where: ___________________________________________________________________
                Day - Month - Year                              Town/County/State/Other

Spouse's Name:__________________________________________ Son/Dau of:____________________________________________________
               Last           First     Middle

List children, if known, on separate page:
Proof enclosed.



GENERATION 6 - Relationship to Applicant: _________________________________________________________________________

________________________________________________________________________________________________________________________
Last Name                                         First                          Middle
 

Date of Birth: ______________________________ Where: ___________________________________________________________________
                Day - Month - Year                              Town/County/State/Other

Date Died: __________________________________ Where: ___________________________________________________________________
                Day - Month - Year                              Town/County/State/Other

Date Married ________________________________ Where: ___________________________________________________________________
                Day - Month - Year                              Town/County/State/Other

Spouse's Name:__________________________________________ Son/Dau of:____________________________________________________
               Last           First     Middle

List children, if known, on separate page:
Proof enclosed.



GENERATION 7 - Relationship to Applicant: _________________________________________________________________________

________________________________________________________________________________________________________________________
Last Name                                         First                          Middle
 

Date of Birth: ______________________________ Where: ___________________________________________________________________
                Day - Month - Year                              Town/County/State/Other

Date Died: __________________________________ Where: ___________________________________________________________________
                Day - Month - Year                              Town/County/State/Other

Date Married ________________________________ Where: ___________________________________________________________________
                Day - Month - Year                              Town/County/State/Other

Spouse's Name:__________________________________________ Son/Dau of:____________________________________________________
               Last           First     Middle

List children, if known, on separate page:
Proof enclosed.


Certificate for which applicant is applying (check one):

  Certificate of Tennessee Ancestry (in Tennessee 1851- 1880)                 _____

  Certificate of Tennessee Ancestry - Settler (in Tennessee 1797 - 1850)      _____

  Certificate of Tennessee Ancestry - Pioneer (in Tennessee prior to 1796)    _____

Check for $10.00 is enclosed                                                  _____

3x5 cards enclosed                                                            _____

Proof for each generation is enclosed                                         _____


RELEASE


I understand that my application and the material submitted with it becomes the property of The Tennessee Genealogical Society, and will be kept in a special collection in the Tennessee Genealogical Society Library, and that all of the material may be published in printed form at some future date.

It is further understood that the material submitted by me can be used by me should I decide to put it in print at a later date.

I, therefore, give permission to The Tennessee Genealogical Society to use all material and data submitted, as they see fit, allowing editing, as needed.

              Signed this _______ day of _______________ 20____
              Signature:_______________________________________
              Address:_________________________________________
                      _________________________________________

Submit completed application to:
Tennessee Genealogical Society
P.O. Box 1824,
Germantown, TN 38183-1824
Contact Society: tngensociety@yahoo.com
©Tennessee Genealogical Society
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