Dar Dna Submission Form

NSDARDNA 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 sonof ______, A______.

name of patriot ancestor number

Section 3: Explanation of Traditional Research Methods (Direct and Indirect Evidence)

______

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 ApplicantDate

Section 6: Lineage from test subject 2 to patriot ancestor

Lineage / Sources
1. (test subject 2)______
was born on ______at ______/ ______
______
2. The said______was the son of
______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 ______/ ______
______
______
______
______

Section 7: Authorization of Test Subject 1

I, ______, verify that I am the ______

Printed name of test subject 1father, 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 1Date

______

E-mail address associated with DNA account

Section 8: Authorization of Test Subject 2

I, ______, verify that I am the ______

Printed name of test subject 2father, brother, grandfather, etc

of DAR member, ______. I also certify that the

printed name of DAR member

______

Signature of Test Subject 2Date

______

E-mail address associated with DNA account