[Texas Society, Sons of the American Revolution (TXSSAR) Membership Records: 233-313] Page: 177 of 389

                                
APPLICATION FOR MEMBERSHIP.
National Number                                                    State Number
ISSUED BY AUTHORITY OF THE NATIONAL BOARD OF TRUSTEES.
TO THE BOARD OF MANAGERS OF
THE TEXAS SOCIETY
OF THE
SONS OF THE AMERICAN REVOLUTION.
I,              h.   t  r; .- -.  .  ---../--embershp in                                ths
Society by right of lineal descent in the following line from..
who was born in.-......t.h..................... n the                  day of    .      17
and died in_----------- ---       -------- -- -- on the               day of1
and who assisted in establishing American Independence
..,
I was born on  Fe-b--  G"384             1      in   C o ri c - i         .           ..
.... ........-_(rown. City                            or County)
and am a resident of  Corsi c n-a
(1)  I am the son of  li l A .  born inareI ce                              Cc..
o  'b2.-14,died in          Euxreic3  SUYri r.r  Ar .      on   June 2       1  C
and  arth      -lQ1e --hs wife, born ini herni            i    .    on  Aug. 24-
died in  Corsi C'31  TeyAL              .-19, marriedint1i .
on JePC.
(2).Grandson of  Thb       1                      ---
borninC            Tenn            on   1810              died in  resden     Te'
on  1i72               ,and Lui ndl   Youn er         his wife, born in
on                   , (lied in              on                  , married in
on
(3)  Great-Grandson of  .  t1h 't  y G
born in .e cklejC17'  C.Ze. ...on Sept..1         n! ci1
..                        . .. . . . . . . . .. . .. . .. . .. .-  -
on                      , and  Eli Znabe t  Dodd       his wife, horn in
on"                  , died in               on, married                inI
................................................ ------ --...
on
(4)  GreatGreat-Grandson of  .ze
born in  PePVPn  1V.nn     4_on                        ,diedoin-
on                       and i.  _ W. f on         --his wife, born in
on                    doed in                                   .n, married in
on
(5 .  Grat-G eatGreat-Grandson  of  V j 11..'. i .P-0.  .-.....-----.1..
born in                            on                     , died in
on                       and  Prijoc)1.j   Roberte . hs wife, bornin
..                        ...- ..--.-  -  -  - --  . . . . --.. . . . .. . . . . . . .. . . . . . ..-. . . . . . .. - -  ------ -   --- - - --  -  - - - - - - - - -
on                   , died in               on                  , married in
---n  -  - - - - - - - - -- - --                                 - - ----- - - - - - -- --- - ---  -----  :- -.. . . .- - --... . .-...-...- _--- - - - - - - - - - - - - - - ---- ----- --
on
(6).Great.Great-Great-Great-Grandson of 5QXhn Polk
horn in                            on                     , died in
......................        .  ... ....... -........ .. .. . . .. .. . .. . .................died.....  ..................... .. . .
on                      , and Johrtnn  Knox            his wife, born in            W*
on               . .  died in                on                  , married in
--     -..-  --..--..-..-- .. --.. -_- - -  --------------- - ---.._.....- - ----  - h
on                      , and he, the said                                        (No    i te
ancestor who assisted in establishing American Independence, while acting in the capacity of
NOTE: It is not essential to admission to membership that all blank spaces for information be filled, but it is extremelY
desirable.
o n" ed and re mmended b  n r"ted members of the  Signatu  a    'c nt, (Name in
ociety'
Re iden
Occupation,