First / Middle Names(Required)Last Name / Suffix(Required)Type of Service(Required)1st Lieutenant1st Sergeant2d Lieutenant2nd Lieutenant2nd MajorAdjutantArtificerBoatswain GunnerBombardierBrevet MajorBrigade MajorBrigadier GeneralCaptainCarpenterChaplainCivil ServiceColonelCommissioner of CorrespondenceCommissaryCornetCorporalCourt Martial ParticipantDoctorDrummerEngineerEnsignFiferFirst SergeantForage MasterGunnerHorsemanLieutenantLieutenant ColonelMajorMajor GeneralMarineMarinerMatrossMidshipmanMilitary ServiceMilitia SergeantMilitiamanMinute ManNaval CaptainNon-Commissioned OfficerNot Rev War PatriotPatriotic ServicePatriotic ServicePaymasterPhysicianPrivatePrivateerPublic ServiceQuartermasterQuartermaster GeneralRangerSailorSargeantScoutSeamanSargentSecond MajorSergeantSergeant-MajorShips CaptainSigner Declaration of IndependenceSoldierSpyStaff OfficerSurgeonTeamsterVolunteerWaggonerPlace of Service(Required)ConnecticutDelewareFranceGeorgiaMarylandMassachusettsNew HampshireNew JerseyNew YorkNorth CarolinaPennsylvaniaRhode IslandSouth CarolinaSpainVermontVirginiaBirth DateFormat: 01 Jan YYYY, or YYYY/YYYYBirth LocationDeath DateFormat: 01 Jan YYYY, or YYYY/YYYYDeath LocationSAR Patriot NumberDAR Patriot NumberThis field is hidden when viewing the formFillerThis field is hidden when viewing the formFillerNotes