Family History Chart

Verification of Indian Preference for Employment in BIA and IHS, 25 CFR5

FamilyHistory1-11-30-07.

Verification of Indian Preference for Employment in BIA and IHS, 25 CFR5

OMB: 1076-0160

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OMB Control # 1076-0160

Expiration Date:04/30/2008

Family History Chart

For Categories B, C & D







(IV) Great-grandfather

BD:_____________

Tribe:

(III) Grandfather


BD:_____________


Tribe:

(IV) Great-grandmother

BD:_____________

Tribe:

(II) Father


BD:_____________


Tribe:


(IV) Great-grandfather

BD:_____________

Tribe:

(III) Grandmother


BD:_____________


Tribe:

(IV) Great-grandmother

BD:_____________

Tribe:

(I) Applicant


BD:_____________ DOB:_____________


Tribe:

(IV) Great-grandfather

BD:_____________

Tribe:

(III) Grandfather


BD:_____________


Tribe:

(IV) Great-grandmother

BD:_____________

Tribe:

(II) Mother


BD:_____________


Tribe:

(IV) Great-grandfather

BD:_____________

Tribe:

(III) Grandmother


BD:_____________


Tribe:

(IV) Great-grandmother

BD:_____________

Tribe:


File Typeapplication/msword
File TitleGreat-great-great-great-grandfather
AuthorDaisy West
Last Modified ByIndian Affairs User
File Modified2007-11-30
File Created2007-11-30

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