Application

Freedmen Descendants of the
5 Civilized Tribes, Inc.

FD5CT, Inc.
9819 Locust, #6
Kansas City, Missouri 64131
BlackIndian@kc.rr.com
Phone# (816) 200-6074 
Membership Application:

                                                                                                  Date___________

Please Check One
Applicant_________ (Must prove lineage from the 1898-1914 Dawes Freedmen Rolls)
Spouse of a Freedmen Descendant ____ (Spouse must be a member, before you can apply provide copy of marriage certificate and Spouse’s name as it appears on the FD5CT, Inc. membership roll)

Membership Annual Dues _____ $50.00 (Jan. to Dec.) (Mail check or money order only).  Applications after  October. 1 will include the following year’s dues. (A CDIH will be provided on verification, needed to be enrolled in your nation) NOTE: Children under 18 initial application is 50.00 renewal 5.00  Adult renewal 50.00) (ANY APPLICATION THAT IS PROCESSED AND NOT APPROVED WILL BE ACCESSED THE 50.00 PROCESSING FEE)
Applicant’s Name (Please Print) ________________________________________________________
Address__________________________________________________________
________________________________________________________________
Phone# ___________________________Email Address__________________

Signature__________________________________________
SHOULD YOU HAVE A PARENT ALREADY ENROLLED  THEIR REGISTRATION NUMBER________________ THEIR NAME____________________________ TRIBE ENROLLED_____________________

YOU CAN SKIP THE REST OF THIS FORM

THE DAWES COMMISSION (Final) ROLL, WILL BE USED FOR VERIFICATION ANYONE WHO DIED PRIOR TO 1899 OR WAS BORN AFTER MARCH 4, 1906 WILL NOT HAVE A ROLL NUMBER

ANCESTOR’S FREEDMEN ROLL NUMBER , NAME and TRIBE (Chickasaw, Choctaw, Seminole, Cherokee or Creek only)________________________________________________
Check one: Parent (  ) Grandparent (  ) Great grandparent (  ) Great-great grandparent  (  )
Specify other___________________________________________________

NEXT GENERATION (MUST PROVIDE BIRTH OR DEATH CERTIFICATION or other supporting document)______________________________________________________________

NEXT GENERATION (MUST PROVIDE BIRTH OR DEATH CERTIFICATION or other supporting document)_____________________________________________________________________

NEXT GENERATION (MUST PROVIDE BIRTH OR DEATH CERTIFICATION or other supporting document)_____________________________________________________________________
ALL SUPPORTING DOCUMENTS AND DUES MUST ACCOMPANY APPLICATIONS, INCOMPLETE APPLICATIONS WILL BE RETURNED.  COPIES OF BIRTH, DEATH and MARRIAGE CERTIFICATES (State issued only) ARE SUBJECT TO STATE VERIFICATION

Received________________________________
Eleanor Wyatt, Board Chairman
Lenise Jamierson Board Member
Evaristo Gaitan, Secretary/Treasure
Frank Allen, Board Member