Lineage
Worksheet
Page 1 of 3
Sons of the American Revolution
My Name: ___________________________ ______________________________ _______________________________
(First)
(Middle)
(Last)
Street, R. D. or PO Box: _______________________________________________________________________________
City: _____________________________________________ State: ____________________ Zip Code: _______-______
Telephone: (_____) _____ - ________ Email Address: _____________________________________________ Age: ____
Occupation: _________________________________________________________________________________________
If submitting for other than a new membership: N# ________________
Society / Chapter: ____________________________________________________________________________________
Having children by bloodline, and not by adoption, by my wife as listed.
Child’s Name
Daughter / Son Wife # Date of Birth
City / County
State
___________________________ ____________ _____ ____________ _____________________ ____________
___________________________ ____________ _____ ____________ _____________________ ____________
___________________________ ____________ _____ ____________ _____________________ ____________
___________________________ ____________ _____ ____________ _____________________ ____________
___________________________ ____________ _____ ____________ _____________________ ____________
I descend from ________________________________ who served the cause for American Independence in the capacity of
___________________________________________________________________________________________________
REFERENCES: _____________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
The patriot ancestor is buried in the ______________________________________________________cemetery, located at
(If known)
________________________________________________________________________________________________________________________________________________________
STATEMENT OF BLOODLINE TO PATRIOT ANCESTOR
(Give all names, dates and places known. Show dates as DD MMM YYYY)
1. I am __________________________________
and my ____ wife_________________________
NSDAR # ________________
(If Remarried)
and my ____ wife________________________
NSDAR # ________________
DATE
CITY / COUNTY / STATE
born ______________
born ______________
died ______________
married ___________
born ______________
died ______________
married ___________
at ________________________________
at ________________________________
at ________________________________
at ________________________________
at ________________________________
at ________________________________
at ________________________________
________________________
REFERENCES: ____________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
2. I am the son of __________________________
NSSAR # ________________
and his ____ wife________________________
NSDAR # ________________
born ______________
died ______________
born ______________
died ______________
married ___________
at ________________________________
at ________________________________
at ________________________________
at ________________________________
at ________________________________
REFERENCES: ____________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Saratoga Battle Chapter - Lineage Worksheet
New (6/2003)
Your Name: ____________________
Page 2 of 3
DATE
3. Grandson of ____________________________
NSSAR # ________________
and his ____ wife _______________________
NSDAR # ________________
born ______________
died ______________
born ______________
died ______________
married ___________
CITY / COUNTY / STATE
at ________________________________
at ________________________________
at ________________________________
at ________________________________
at ________________________________
REFERENCES: ___________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. Great Grandson of _______________________
and his ____ wife________________________
born ______________
died ______________
born ______________
died ______________
married __________
at ________________________________
at ________________________________
at ________________________________
at ________________________________
at ________________________________
REFERENCES: ___________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. Great Grandson1 of ______________________
and his ____ wife _______________________
born ______________
died ______________
born ______________
died ______________
married ___________
at ________________________________
at ________________________________
at ________________________________
at ________________________________
at ________________________________
REFERENCES: ___________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
6. Great Grandson2 of ______________________
and his ____ wife _______________________
born ______________
died ______________
born ______________
died ______________
married ___________
at ________________________________
at ________________________________
at ________________________________
at ________________________________
at ________________________________
REFERENCES: ___________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7. Great Grandson3 of ______________________
and his ____ wife _______________________
born ______________
died ______________
born ______________
died ______________
married ___________
at ________________________________
at ________________________________
at ________________________________
at ________________________________
at ________________________________
REFERENCES: ___________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Saratoga Battle Chapter - Lineage Worksheet
New (6/2003)
Your Name: ____________________
Page 3 of 3
DATE
4
8. Great Grandson of _____________________
and his ____ wife ______________________
born ______________
died ______________
born ______________
died ______________
married____________
CITY / COUNTY / STATE
at ________________________________
at ________________________________
at ________________________________
at ________________________________
at ________________________________
REFERENCES: ___________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
9. Great Grandson5 of _____________________
born ______________ at ________________________________
died ______________ at ________________________________
and his ____ wife ______________________ born ______________ at ________________________________
died ______________ at ________________________________
married ___________ at ________________________________
REFERENCES: ___________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
10. Great Grandson6 of_______________________
and his ____ wife________________________
born ______________
died ______________
born ______________
died ______________
married ___________
at ________________________________
at ________________________________
at ________________________________
at ________________________________
at ________________________________
REFERENCES: ___________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
11. Great Grandson7 of_______________________
and his ____ wife________________________
born ______________
died ______________
born ______________
died ______________
married ___________
at ________________________________
at ________________________________
at ________________________________
at ________________________________
at ________________________________
REFERENCES: ___________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
12. Great Grandson8 of_______________________
and his ____ wife________________________
born ______________
died ______________
born ______________
died ______________
married ___________
at ________________________________
at ________________________________
at ________________________________
at ________________________________
at ________________________________
REFERENCES: ___________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Saratoga Battle Chapter - Lineage Worksheet
New (6/2003)