INSTRUCTIONS: The “Short Form” to be used only when the S.R. connection can be made within the first four generations shown
on page 3. Otherwise the full “Long Form” must be used. The State Society Registrar or the General Society Registrar will reject the
“Short Form” if papers of connecting ancestor do NOT meet these requirements.
_________________
State Soc. No.
________________
General Soc. No.
Sons of the Revolution
State of New York
STATE HEADQUARTERS
FRAUNCES TAVERN
54 PEARL STREET
NEW YORK, N.Y. 10004
SHORT FORM APPLICATION FOR MEMBERSHIP
Applicant:
Street:
City:
, State:
Zip:
Telephone:
Email:
Ancestor:
The within named applicant recommended to the Board of Managers for admission by
the
Society
Dated: ___________________________ Secretary: _____________________________
Approved as to Eligibility for Membership
Dated: ___________________________ Registrar: _____________________________
Elected by the Board of Managers __________ 20_____, conditional on payment of the
Initiation Fee.
__________________________________________
Secretary of the Sons of the Revolution
Notified: _____________________20_____
Qualified: ____________________20_____
Date of Application:
TO THE BOARD OF MANAGERS OF the:
Society.
APPLICANT USE EITHER A or B BELOW
A. Name of S.R. Ancestor:
this State Society:
State Soc. No.:
General Soc. No.:
B. If the applicant has an S.R. member (blood) brother, sharing the same connecting
ancestor, he will state:
Name of brother:
his state Society:
State Soc. No.:
General Soc. No.:
I, (full name)
hereby apply for membership in this Society by right of descent from
(Name of Revolutionary War ancestor from whom eligibility is derived)
who was born at:
on:
17 ; was a resident of:
and died at:
on:
.
His services in assisting in the establishment of American Independence during the War
of the Revolution, upon which my claim of eligibility to membership is based, were as
follows:
Service (Giving dates and particulars of service performed by your ancestor while acting as soldier, sailor, or marine, or as a
military, naval or civil officer):
I declare upon honor, that if admitted to membership in this Society I will endeavor to
promote the purposes of its Institution and observe the Constitution and By-Laws of this
Society and support the Constitution of the United States.
Signature of Applicant: ____________________________________________________
Profession or Occupation:
Residence:
Business Address:
[Please indicate to which address mail should be sent.]
[Declaration required by the Constitution of the Society. Applicant not a citizen of the United States may omit that part of the
declaration.]
We, the undersigned members of this State Society, approve and recommend the
foregoing application for membership in this Society, and know the said applicant to be
worthy, and will if admitted, be a desirable member. [The approval of two members is necessary before this
application can be considered.
Proposer:
Seconder:
When the applicant derives eligibility of membership from more than one ancestor, and it
is desired to take advantage thereof, separate applications to be marked “Supplemental
Application,” and numbered like the original, should be made out for each case, and filed.
All applications are the property of the Society, and after submission must remain on file.
ALL APPLICATIONS MUST BE EXECUTED IN DUPLICATE, AS THERE IS A
STATE AND GENERAL SOCIETY
THIS AFFIDAVIT MUST BE MADE AND SWORN TO BY THE APPLICANT
[Give all names in full, locations and dates where possible]
AFFIDAVIT IN SUPPORT OF APPLICATION OF
Full name of Applicant:
State:
County:
FOR MEMBERSHIP IN THE SONS OF THE REVOLUTION
(A): I the applicant
being duly sworn say I was,
Born on:
at:
and is a citizen of
(B): That he is the blood brother of [name of S.R. Brother]
Born on:
at:
Applicant:
Married on:
to:
Born at:
on:
Died at:
on:
Married at:
Proofs:
The Said
was the son of:
2.
Born at:
on:
Died at:
on:
Married on:
to:
Born at:
on:
Died at:
on:
Married at:
The Said
was the son of:
3.
Born at:
on:
Died at:
on:
Married on:
to:
Born at:
on:
Died at:
on:
Married at:
Proofs:
The Said
was the son of:
4.
Born at:
on:
Died at:
on:
Married on:
to:
Born at:
on:
Died at:
on:
Married at:
Proofs:
And deponent further says that the said [Name of Revolutionary War ancestor from whom eligibility is derived]
is the ancestor mentioned in the foregoing application, and that said ancestor at no
time after the service above set forth, adhered to the enemy or failed to maintain an
honorable record throughout the War of the Revolution, and that the facts hereinbefore
set forth are true, to the best of his knowledge and belief, and that he has not applied for
and failed of admission in this, or any other State Society of the “Sons of the
Revolution,” or any Chapter or Association thereof.
That to the best of the deponent’s knowledge and belief the line of descent set forth above
is lineal and not in any case by adoption.
Subscribed and sworn before me,
This_____ day of ___________
A.D. _____________________
Signature of Deponent: ____________________
Notary:__________________________________________
Additional Facts:
Your military and/or public service, schools attended, degrees attained, club affiliations,
etc. Any details likely to proof of interest to the Historian of the Society, or to your
posterity, may be written here.
Children [ with dates and places of birth]:
______________________________________
Signature of Applicant