CONFEDERATE ANCESTOR

    The Confederate patriot through whom I petition for membership, and who adhered to the Cause of the Confederate States of America, was my:


    whose name was


    of



    My (check one)
    Lineal
    Collateral

    Confederate Ancestor was a


    In Company


    My Confederate Ancestor was:

    Paroled

    Surrendered

    Released On Oath

    Discharged

    Killed

    Died

    Died on


    Who are you?