4 - Patent+of+Nativity-original Template

PATENT OF NATIVITY
For the nativity of: First Middle of the family Birth Last Name
Date of nativity: 4th day of April A.D. 1974 {Your Picture

Here}
Place of nativity: Birth State Republic
Record of Genealogy:
Paternal Genealogy Maternal Genealogy

----------------------------------------------------------------- -----------------------------------------------------------------
Michael Andrew Doe Julie Marie Edwards
(Father) (Mother)
----------------------------------------------------------------- -----------------------------------------------------------------
William Harry Doe, Sr. Sandra Theresa Picard Paul Detner Edwards Helen Eileen Hindall
(Grandfather) (Grandmother) (Grandfather) (Grandmother)
State born Republic State born Republic State born Republic State born Republic
Birth - death years birth – death years birth – death years birth – death years
--------------------------------------- --------------------------------------- --------------------------------------- ---------------------------------------
William Peter Doe Armand Picard, Jr. Thomas Alfred Edwards Alvin Hindall
(Great Grandfather) (Great Grandfather) (Great Grandfather) (Great Grandfather)
birth - death years birth – death years birth – death years birth – death years
Olivia McGee Emily Marguerite Chavier Lola Mae Cunningham Esther Shearer
(Great Grandmother) (Great Grandmother) (Great Grandmother) (Great Grandmother)
birth - death years birth - death years birth – death years birth – death years
--------------------------------------- --------------------------------------- --------------------------------------- ---------------------------------------
Jules Doe, Sr. Armand Picard, Sr. William Nary Edwards Charles Hindall
(Great Great Grandfather) (Great Great Grandfather) (Great Great Grandfather) (Great Great Grandfather)
birth - death years birth - death years birth – death years birth – death years
Mary Boutte Noemie Hains Sarah Jane Johnson Wolfgang Wolheter

(Great Great Grandmother) (Great Great Grandmother) (Great Great Grandmother) (Great Great Grandmother)
birth - death years birth – death years birth – death years birth – death years
-------------------------------------- --------------------------------------------- --------------------------------------------- ---------------------------------------
Harry McGee Anthony Chavier, Sr. William Mathew Cunningham

(3rd Great Grandfather) (3rd Great Grandfather) (3rd Great Grandfather)
State born Republic State born Republic State born Republic
birth – death years birth – death years birth – death years
Mary Malus Emily Anne Matthews Mary Jane Oliver

(3rd Great Grandmother) (3rd Great Grandmother) (3rd Great Grandmother)
birth – death years birth – death years birth – death years
--------------------------------------- --------------------------------------- ---------------------------------------
Leopold Paul Doe J.B. Chavier Alfred Edwards
(4th Great Grandfather) (4th Great Grandfather) (4th Great Grandfather)
born - death years birth – death years birth – death years
Marie Antoinette Cordonier Anaise Anne Dupre Ruth Windland

(4th Great Grandmother) (4th Great Grandmother) (4th Great Grandmother)
born - death years birth – death years birth – death years
--------------------------------------- ---------------------------------------
---------------------------------------
Witness: Witness: Principal claimant:

I hereby solemnly affirm that the information in this I hereby solemnly affirm that the information in this I hereby solemnly affirm that the information in this
patent is true and correct to the best of my knowledge. patent is true and correct to the best of my knowledge. patent is true and correct to the best of my knowledge.
_______________________________ _______________________________ _______________________________

First Witness Second Witness Native You autograph here – delete
before printing
PATENT OF
NATIVITY
For the nativity of:
First MiddleName
of the family Birth Last Name
Date of nativity:
1 Day of Birth Month
st
A.D. Birth Year
This document serves as Proof

that my living DNA existed on this
Land before there was a UNITED
STATES of America or Any STATE
Thereof

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PATENT OF NATIVITY

Date of nativity: 4th day of April A.D. 1974 {Your Picture

Paternal Genealogy Maternal Genealogy

Mary Boutte Noemie Hains Sarah Jane Johnson Wolfgang Wolheter

Harry McGee Anthony Chavier, Sr. William Mathew Cunningham

Mary Malus Emily Anne Matthews Mary Jane Oliver

Marie Antoinette Cordonier Anaise Anne Dupre Ruth Windland

Witness: Witness: Principal claimant:

_______________ _ _________________

For the nativity of:

A.D. Birth Year

This document serves as Proof

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