Erie Indian Moundbuilders Tribal Nation

The Erie Indian Moundbuilders Tribal Nation
Statement of Fact

1. I ______________________________________swear the information submitted on my
chart is fact and is true to the best of my knowledge.

2. Information obtained for the Genealogy Ancestry Chart was obtained from
(Check applicable below):

[____] Family Bible
[____] Census (year:________)
[____] Passed down through family
[____] Death Certificate seen but not in possession
[____] Historical Quarterly (where:________________________________________)
Other (explain: attach additional pages if needed:
[____] Other ________________________________________________________________
[____] Other ________________________________________________________________
[____] Other ________________________________________________________________
[____] Other ________________________________________________________________

3. [____] Attach a copy of your Family Tree

                                                                               Signed______________________________________

         State of_______________________________________________

         County of _____________________________________________

         On the __________day ________in the year __________personally appeared to me the above named

          ____________________________________and acknowledged the forgoing to be (his/her) voluntary set deed.

 

         Applicants name:_______________________________                Notary Public for_____________________

         Address:_____________________________________                  My Commission expires_______________

         City:_________________________________________                                       

         Phone:_______________________________________

         Applicants date of birth:__________________________



Please return application to :
address
address
address
Phone:
Email:

                                               Copyright © 2005-2009 Erie Indian Moundbuilders Tribal Nation. All Rights Reserved.
                                               tecumseh@eriemoundbuilders.com