Download "Request Form for Confidential Information - White Earth Reservation Tribal Council Tribal Enrollments" - Minnesota
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1White Earth Reservation Tribal Council Tribal Enrollments
REQUEST FOR CONFIDENTIAL INFORMATION
P.O. Box 506
Phone: (218) 983-3285
White Earth, Minnesota 56591
Fax:
(218) 983-3707
REQUEST FOR:
[ ] Indian Preference BIA Form 4432
[ ] Certificate of Degree of Indian Blood (CDIB)
[ ] Tribal Enrollment Card
[ ] Other (explain): ___________________________________________________________________
** NOTE: For proof of decendency, please use the Request for Verification of Decendency Form
IDENTIFICATION:
Name: ______________________________________________________________________________
(First)
(Middle)
(Maiden)
(Last)
DOB: _____________________________
(Month)
(Day)
(Year)
Current Mailing Address:
____________________________________________________________________________________
(Address)
(City)
(State)
(Zip)
** NOTE:
This address will be used to update your Enrollment record if it is different than what we have on file
Telephone Number: ____________________________________________
If request is for a minor, proof of legal guardianship must be included such as certified birth certificate
along with documentation of any name change(s):
Relationship: ______________________________
Print Name of Requestor: ________________________________________________________________
Signature: __________________________________________________
Date: ____________________________________
White Earth Reservation Tribal Council Tribal Enrollments
REQUEST FOR CONFIDENTIAL INFORMATION
P.O. Box 506
Phone: (218) 983-3285
White Earth, Minnesota 56591
Fax:
(218) 983-3707
REQUEST FOR:
[ ] Indian Preference BIA Form 4432
[ ] Certificate of Degree of Indian Blood (CDIB)
[ ] Tribal Enrollment Card
[ ] Other (explain): ___________________________________________________________________
** NOTE: For proof of decendency, please use the Request for Verification of Decendency Form
IDENTIFICATION:
Name: ______________________________________________________________________________
(First)
(Middle)
(Maiden)
(Last)
DOB: _____________________________
(Month)
(Day)
(Year)
Current Mailing Address:
____________________________________________________________________________________
(Address)
(City)
(State)
(Zip)
** NOTE:
This address will be used to update your Enrollment record if it is different than what we have on file
Telephone Number: ____________________________________________
If request is for a minor, proof of legal guardianship must be included such as certified birth certificate
along with documentation of any name change(s):
Relationship: ______________________________
Print Name of Requestor: ________________________________________________________________
Signature: __________________________________________________
Date: ____________________________________
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Most popular documents
-
DA Form 2062 "Hand Receipt/Annex Number"
-
DD Form 2977 "Deliberate Risk Assessment Worksheet"
-
DA Form 31 "Request and Authority for Leave"
-
DD Form 1750 "Packing List"
-
IRS Form W-2 "Wage and Tax Statement"
-
DD Form 1351-2 "Travel Voucher or Subvoucher"
-
DA Form 3595 "Record Fire Scorecard"
-
DD Form 2923 "Privacy Act Data Cover Sheet"
-
DD Form 2813
-
DD Form 2656 "Data for Payment of Retired Personnel"
Popular Articles
- 2020 Tax Deductions for Homeowners 2020 Tax Deductions for Homeowners
- How to Convert Personal Use Property to Business Use? How to Convert Personal Use Property to Business Use?
- How to Rent Your First Apartment? How to Rent Your First Apartment?
- How To Buy a House in the United States? How To Buy a House in the United States?
- USCIS Form I-551, Permanent Resident Card USCIS Form I-551, Permanent Resident Card
- Washington State Patrol Inspection Request Form Washington State Patrol Inspection Request Form
- Form MV-4ST, Vehicle Sales and Use Tax Return/Application for Registration Form MV-4ST, Vehicle Sales and Use Tax Return/Application for Registration
- USCIS Form I-797C, Notice of Action USCIS Form I-797C, Notice of Action
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