GENERATION 1 - Relationship to Applicant ___________________________________________ Name of Tennessee
Ancestor from whom you claim descent (this will be the Ancestor whose name
appears on certificate.)
________________________________________________________________________________________________________________________
Date of Birth: ______________________________
Place of Birth: __________________________________________________________
Date Died: __________________________________
Place of Death: __________________________________________________________
Place Buried: __________________________________________________________________________________________________________
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.
_________________________________________________________________________________________________________________________ Name of spouse of
ancestor (and marriage data if known):
________________________________________________________________
Son/Dau of:_____________________________________________
Date Married:______________________________________
Place Married: ______________________________________________________
If not first marriage, indicate other marriage data: ____________________________________________________________________ Children: (List your
direct ancestor first. Additional names/data may be listed on extra
sheet.)
_________________________________________________________________________________________________________________________
List documented proof attached. (If printed sources, show Title, Author, Page No.) GENERATION 2 - Relationship to Applicant: _________________________________________________________________________ ________________________________________________________________________________________________________________________
Date of Birth: ______________________________
Where: ___________________________________________________________________
Date Died: __________________________________
Where: ___________________________________________________________________
Date Married ________________________________
Where: ___________________________________________________________________
Spouse's Name:__________________________________________
Son/Dau of:____________________________________________________
List children, if
known, on separate page:
GENERATION 3 - Relationship to Applicant: _________________________________________________________________________ ________________________________________________________________________________________________________________________
Date of Birth: ______________________________
Where: ___________________________________________________________________
Date Died: __________________________________
Where: ___________________________________________________________________
Date Married ________________________________
Where: ___________________________________________________________________
Spouse's Name:__________________________________________
Son/Dau of:____________________________________________________
List children, if
known, on separate page:
GENERATION 4 - Relationship to Applicant: _________________________________________________________________________ ________________________________________________________________________________________________________________________
Date of Birth: ______________________________
Where: ___________________________________________________________________
Date Died: __________________________________
Where: ___________________________________________________________________
Date Married ________________________________
Where: ___________________________________________________________________
Spouse's Name:__________________________________________
Son/Dau of:____________________________________________________
List children, if
known, on separate page:
GENERATION 5 - Relationship to Applicant: _________________________________________________________________________ ________________________________________________________________________________________________________________________
Date of Birth: ______________________________
Where: ___________________________________________________________________
Date Died: __________________________________
Where: ___________________________________________________________________
Date Married ________________________________
Where: ___________________________________________________________________
Spouse's Name:__________________________________________
Son/Dau of:____________________________________________________
List children, if
known, on separate page:
GENERATION 6 - Relationship to Applicant: _________________________________________________________________________ ________________________________________________________________________________________________________________________
Date of Birth: ______________________________
Where: ___________________________________________________________________
Date Died: __________________________________
Where: ___________________________________________________________________
Date Married ________________________________
Where: ___________________________________________________________________
Spouse's Name:__________________________________________
Son/Dau of:____________________________________________________
List children, if
known, on separate page:
GENERATION 7 - Relationship to Applicant: _________________________________________________________________________ ________________________________________________________________________________________________________________________
Date of Birth: ______________________________
Where: ___________________________________________________________________
Date Died: __________________________________
Where: ___________________________________________________________________
Date Married ________________________________
Where: ___________________________________________________________________
Spouse's Name:__________________________________________
Son/Dau of:____________________________________________________
List children, if
known, on separate page:
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 _____
Signed this _______ day of _______________ 20____
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