"Family History Chart for Categories B,c & D"

Family History Chart for Categories B,c & D is a 1-page legal document that was released by the U.S. Department of the Interior - Bureau of Indian Affairs and used nation-wide.

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OMB Control # 1076-0160
Expiration Date:03-31/2021
Family History Chart
For Categories B, C & D
(IV) Great-grandfather
BD:_____________
Tribe:
(III) Grandfather
BD:_____________
(IV) Great-grandmother
Tribe:
BD:_____________
Tribe:
(II) Father
BD:_____________
(IV) Great-grandfather
Tribe:
BD:_____________
(III) Grandmother
Tribe:
BD:_____________
(IV) Great-grandmother
Tribe:
BD:_____________
(I) Applicant
Tribe:
BD:_____________ DOB:_____________
(IV) Great-grandfather
Tribe:
BD:_____________
Tribe:
(III) Grandfather
BD:_____________
(IV) Great-grandmother
Tribe:
BD:_____________
(II) Mother
Tribe:
BD:_____________
(IV) Great-grandfather
Tribe:
BD:_____________
(III) Grandmother
Tribe:
BD:_____________
(IV) Great-grandmother
Tribe:
BD:_____________
Tribe:
OMB Control # 1076-0160
Expiration Date:03-31/2021
Family History Chart
For Categories B, C & D
(IV) Great-grandfather
BD:_____________
Tribe:
(III) Grandfather
BD:_____________
(IV) Great-grandmother
Tribe:
BD:_____________
Tribe:
(II) Father
BD:_____________
(IV) Great-grandfather
Tribe:
BD:_____________
(III) Grandmother
Tribe:
BD:_____________
(IV) Great-grandmother
Tribe:
BD:_____________
(I) Applicant
Tribe:
BD:_____________ DOB:_____________
(IV) Great-grandfather
Tribe:
BD:_____________
Tribe:
(III) Grandfather
BD:_____________
(IV) Great-grandmother
Tribe:
BD:_____________
(II) Mother
Tribe:
BD:_____________
(IV) Great-grandfather
Tribe:
BD:_____________
(III) Grandmother
Tribe:
BD:_____________
(IV) Great-grandmother
Tribe:
BD:_____________
Tribe: