NAAIP AFFIDAVIT OF ANCESTRY
Published on: Mar 3, 2016
Transcripts - NAAIP AFFIDAVIT OF ANCESTRY
NATIONAL ASSOCIATION for the ADVANCEMENT OF INDIGENOUS PEOPLE
AFFIDAVIT OF ANCESTRY
My name is _______________________________________________. I am _______ years of age and of sound mind.
My date of Arrival (“Birth”) is __________________________ in the city and state______________________________.
(Example: January 1, 1999)
I live at ____________________________________________. I have been there_____ years /months/ days.
I am the son /daughter (circle one) of________________________________& ___________________________________.
(Mother’s Full Name) (Father’s Full Name)
I submit this Affidavit to affirm my ancestral bloodline as _______________________________ (Seminole, Choctaw, etc.) based
on first-hand knowledge from family stories, information, and / or historical documentation from my mother, father,
grandmother, and / or grandfather, and / or other relatives.
I am a citizen / member of _______________________________ American Indian tribe / nation. (Put N/A if none.)
In witness whereof, I set my hand _________________________________________; signed on the _____ day
of ___________________________ 2014, in the City of ______________________________, in
Using a notary on this document does not constitute any adhesion, nor does it alter my status in any manner. The
purpose for notary is verification and identification only and not for entrance into any foreign jurisdiction.
Subscribed and affirmed to before me, a Notary Public in and for the County of _______________________________,
and State of _____________________________, on this _____ day of __________________ in the year
(Notary Print Name)
My commission expires on: ______________________
My address: _______________________________________________