I,  ________________________________ was born in ______  See Acceptable Documents No. 2.
	FULL NAME				   YEAR 
at __________________________________________________			Doc No. ______
	CITY	COUNTY	STATE
I married (optional)_________________________  on________________________
at __________________________________________________			Doc No. ______
	CITY	COUNTY	STATE

I am the child of ________________________________________________	Doc No. ______
			FULL NAME FATHER
who was born on_________ at _________________________________________	Doc No. ______
		DATE*		CITY	COUNTY	STATE
and died on    _________ at _________________________________________	Doc No. ______
		DATE		CITY	COUNTY	STATE
       and          __________________________________________________	Doc No. ______
			FULL NAME MOTHER
who was born on_________ at _________________________________________	Doc No. ______
		DATE*		CITY	COUNTY	STATE
and died on   _________ at _________________________________________	Doc No. ______
		DATE		CITY	COUNTY	STATE
they married on _________ at _________________________________________	Doc No. ______
		DATE		CITY	COUNTY	STATE


The said        ________________________________________
		FULL NAME FATHER - or MOTHER - from  above
is the child of ____________________________________________________	Doc No. ______
		FULL NAME FATHER
who was born on_________ at _________________________________________	Doc No. ______
		DATE*		CITY	COUNTY	STATE
and died on    _________ at _________________________________________	Doc No. ______
		DATE		CITY	COUNTY	STATE
       and    __________________________________________________	Doc No. ______
		FULL NAME MOTHER
who was born on_________ at _________________________________________	Doc No. ______
		DATE*		CITY	COUNTY	STATE
and died on     _________ at _________________________________________	Doc No. ______
		DATE		CITY	COUNTY	STATE
they married on _________ at _________________________________________	Doc No. ______
		DATE		CITY	COUNTY	STATE


The said        ________________________________________
		FULL NAME FATHER - or MOTHER - from  above
is the child of ____________________________________________________	Doc No. ______
		FULL NAME FATHER
who was born on_________ at _________________________________________	Doc No. ______
		DATE*		CITY	COUNTY	STATE
and died on    _________ at _________________________________________	Doc No. ______
		DATE		CITY	COUNTY	STATE
       and    __________________________________________________	Doc No. ______
		FULL NAME MOTHER
who was born on_________ at _________________________________________	Doc No. ______
		DATE*		CITY	COUNTY	STATE
and died on     _________ at _________________________________________	Doc No. ______
		DATE		CITY	COUNTY	STATE
they married on _________ at _________________________________________	Doc No. ______
		DATE		CITY	COUNTY	STATE



The said        ________________________________________
		FULL NAME FATHER - or MOTHER - from  above
is the child of ____________________________________________________	Doc No. ______
		FULL NAME FATHER
who was born on_________ at _________________________________________	Doc No. ______
		DATE*		CITY	COUNTY	STATE
and died on    _________ at _________________________________________	Doc No. ______
		DATE		CITY	COUNTY	STATE
       and    __________________________________________________	Doc No. ______
		FULL NAME MOTHER
who was born on_________ at _________________________________________	Doc No. ______
		DATE*		CITY	COUNTY	STATE
and died on     _________ at _________________________________________	Doc No. ______
		DATE		CITY	COUNTY	STATE
they married on _________ at _________________________________________	Doc No. ______
		DATE		CITY	COUNTY	STATE



The said        ________________________________________
		FULL NAME FATHER - or MOTHER - from  above
is the child of ____________________________________________________	Doc No. ______
		FULL NAME FATHER
who was born on_________ at _________________________________________	Doc No. ______
		DATE*		CITY	COUNTY	STATE
and died on    _________ at _________________________________________	Doc No. ______
		DATE		CITY	COUNTY	STATE
       and    __________________________________________________	Doc No. ______
		FULL NAME MOTHER
who was born on_________ at _________________________________________	Doc No. ______
		DATE*		CITY	COUNTY	STATE
and died on     _________ at _________________________________________	Doc No. ______
		DATE		CITY	COUNTY	STATE
they married on _________ at _________________________________________	Doc No. ______
		DATE		CITY	COUNTY	STATE




IF THE LAST NAMED PERSON ABOVE IS A SIBLING OF THE SOLDIER, 
PLEASE FILL IN THE FOLLOWING:
The said         ________________________________________
		SIBLING (NAMED ABOVE)
is a SIBLING of    ____________________________________________________	Doc No. ______
		SOLDIER
who served in the ___________________________________________________	Doc No. ______
		MILITARY UNIT, COMPANY, STATE (AS APPLICABLE)
soldier was born  _________ at ______________________________________	Doc No. ______
		DATE		CITY	COUNTY	STATE
and died on      _________ at _________________________________________	Doc No. ______
		DATE		CITY	COUNTY	STATE
soldier’s parents are _________________________________________________	Doc No. ______
			FULL NAME FATHER	FULL NAME MOTHER
they married on _________ at _________________________________________	Doc No. ______
		DATE		CITY	COUNTY	STATE



APPROVED BY: SCCGS Committee Chair________________________________	Date: ______

APPROVED BY: SCCGS Committee Chair________________________________	Date: ______