Name *

First Name

Last Name

Phone *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Age *

I declare that I am 18 years of age or older

Yes

No

Apical Ancestry *

I am a Danggan Balun Person, being a member of the following Group

1. Sarah Warri/Warru Clarke;

2. George Daramlee Drumley;

3. Jack Slab/Slabb Snr (husband of Lizzie Waggi/Slabb & father of Charlotte, Frank, John/Jack Jnr, Olive & Victor;

4. Kitty Blow (wife of Joseph Blow & mother of Frank Blow & Hughie Blow);

5. Bilin Bilin aka Bilinba Jackey aka Jackey Jackey aka John “Johnny” Logan (father of Emily Logan & Johnny Logan);

6. Kipper Tommy Andrews (father of Lizzie Malay (nee Tommie));

7. Billy Terribah/Didiba Andrews;

8. Julia Sandy (wife of Arthur Ford);

9. Kitty Sandy, the mother of Arthur Ford;

10. Mary Ann Sandy nee Mitchell (mother of Mary Ann Drumley (nee Sandy), Ida Bell (nee Sandy), Janet Sandy, Norman Sandy Snr & Lindsay Sandy);

11. William “Billy” Mitchell and his wife, Lizzie Sandy;

12. Unnamed mother of Matilda “Mittie” Fogarty (nee Sandy) and Lizzie (mother of William “Billy” Stanley Brown Jnr);

13. Coolum (husband of Nancy Culham (nee Coolwell) & father of Joseph “Joe”, Maude, Lucy & Lena);

14. Unnamed mother of Nancy Culham (nee Coolwell) (wife of Coolum & mother of Joseph “Joe”, Maude, Lucy & Lena);

15. Yarry (father of Frederick “Fred” Yarrie/Yarry;

16. Jennie, mother of Joseph Coolwell (husband of Polly Allen/Dalton & father of Alice Edwards (nee Coolwell), Alfred Coolwell Jnr, Eva, Edward, Rose, Campbell, Michael & Andrew);

17. Polly Allen/Dalton (wife of Joseph Coolwell & mother of Eva, Edward, Rose, Campbell, Michael & Andrew);

18. Unnamed mother of Elizabeth Tomes/ Clark nee Wheeler;

19. Jim Edwards Snr (husband of Topsy (of Ipswich) & father of Jimmy Edwards Jnr);

20. William Williams (Snr);

21. Bullum Bullum aka John Allen;

22. Alice/Alison Parsons nee Moree, mother of Thomas Parsons;

23. John “Johnny” Bungaree / Bungary (father of Norman Sandy Snr, Lindsay Sandy and Stella Bungera/Bungary).

Confirmation

I acknowledge that the information provided herein is true and correct to the best of my knowledge and that the Danggan Balun Aboriginal Corporation and/or its representatives may cross-reference, verify, and/or conduct further inquiries with other organisations, including but not limited to, Queensland South Native Title Services, for the purposes of assuring its accuracy:

Agree