NSDAR
DNA REPORT FORM
DNA REPORT
Section 1: Applicant/Member Information
Name: __________________________________________________________________
National Number: ________
Section 2: Statement of Purpose
The purpose of this submission is to establish lineage through _____________________,
name of child of patriot
who was the son of ________________________, A__________.
name of patriot
ancestor number
Section 3: Explanation of Traditional Research Methods (Direct and Indirect Evidence)
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Section 4: Test Subjects
Test Subject 1 (close male relative of applicant):
Name: ________________________________ Relationship to applicant: ____________
father, brother, grandfather, etc
Test Subject 2:
National Number of member who descends from this ancestor: _________
Name of male relative of that member: _______________________________________
Relationship between test subject and member: ________________________________
father, brother, grandfather, etc
Section 5: Authorization of Applicant
___________________________________________
Signature of Applicant
________________________
Date
©National Society Daughters of the American Revolution, January 2014
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NSDAR
DNA REPORT FORM
Section 6: Lineage from test subject 2 to patriot ancestor
Lineage
1. (test subject 2)_________________________________________________
was born on __________________at _____________________________
2. The said__________________________________________ was the son of
Sources
_________________
_________________
________________________born_____________at_____________________
Died at__________________on _______________and his ( ) wife
________________________born_____________at_____________________
Died at__________________on _______________Married – Date _________
at ____________________
_________________
_________________
_________________
_________________
_________________
3. The said__________________________________________ was the son of
________________________born_____________at_____________________
Died at__________________on _______________and his ( ) wife
________________________born_____________at_____________________
Died at__________________on _______________Married – Date _________
at ____________________
_________________
_________________
_________________
_________________
_________________
4. The said__________________________________________ was the son of
________________________born_____________at_____________________
Died at__________________on _______________and his ( ) wife
________________________born_____________at_____________________
Died at__________________on _______________Married – Date _________
at ____________________
_________________
_________________
_________________
_________________
_________________
5. The said__________________________________________ was the son of
_________________
_________________
_________________
_________________
_________________
________________________born_____________at_____________________
Died at__________________on _______________and his ( ) wife
________________________born_____________at_____________________
Died at__________________on _______________Married – Date _________
at ____________________
6. The said__________________________________________ was the son of
________________________born_____________at_____________________
Died at__________________on _______________and his ( ) wife
________________________born_____________at_____________________
Died at__________________on _______________Married – Date _________
at ____________________
_________________
_________________
_________________
_________________
_________________
7. The said__________________________________________ was the son of
________________________born_____________at_____________________
Died at__________________on _______________and his ( ) wife
________________________born_____________at_____________________
Died at__________________on _______________Married – Date _________
at ____________________
_________________
_________________
_________________
_________________
_________________
8. The said__________________________________________ was the son of
________________________born_____________at_____________________
Died at__________________on _______________and his ( ) wife
________________________born_____________at_____________________
Died at__________________on _______________Married – Date _________
at ____________________
_________________
_________________
_________________
_________________
_________________
9. The said__________________________________________ was the son of
________________________born_____________at_____________________
Died at__________________on _______________and his ( ) wife
________________________born_____________at_____________________
Died at__________________on _______________Married – Date _________
at ____________________
_________________
_________________
_________________
_________________
_________________
©National Society Daughters of the American Revolution, January 2014
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NSDAR
DNA REPORT FORM
Section 7: Authorization of Test Subject 1
I, _____________________________________, verify that I am the ________________
Printed name of test subject 1
father, brother, grandfather, etc
of DAR applicant, ____________________________________. I also certify that the
printed name of applicant
Y-DNA results represented in this report are my own. I understand that these results
will be used as proof of lineage for a DAR application or supplemental application but
that the test results will be restricted from public access for a period of 75 years from
the date of this report.
I also agree that I will promptly comply with any requests that I may receive to join a
specified DNA Group or Project. I also understand that only the administrator(s) of this
group will have access to my test results and that this access will only be used for the
purposes of establishing lineage for a DAR application or supplemental application.
___________________________________________
Signature of Test Subject 1
________________________
Date
________________________________________________________________________
E-mail address associated with DNA account
©National Society Daughters of the American Revolution, January 2014
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NSDAR
DNA REPORT FORM
Section 8: Authorization of Test Subject 2
I, _____________________________________, verify that I am the ________________
Printed name of test subject 2
father, brother, grandfather, etc
of DAR member, ____________________________________. I also certify that the
printed name of DAR member
Y-DNA results represented in this report are my own. I understand that these results
will be used as proof of lineage for a DAR application or supplemental application but
that the test results will be restricted from public access for a period of 75 years from
the date of this report.
I also agree that I will promptly comply with any requests that I may receive to join a
specified DNA Group or Project. I also understand that only the administrator(s) of this
group will have access to my test results and that this access will only be used for the
purposes of establishing lineage for a DAR application or supplemental application.
___________________________________________
Signature of Test Subject 2
________________________
Date
________________________________________________________________________
E-mail address associated with DNA account
©National Society Daughters of the American Revolution, January 2014
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