|
I. |
To get a Tribal ID: (1) please fill in the information.
(2) Sign in the Signature Block, and
(3) send in this form, along with a passport photo and a $11.00 processing fee
($10.00 per card + $1.00 per card postage & processing). A separate form,
photo and fee need to be submitted for each person. Please do not wear a cap or
hat in photo and do not paper clip photo to paper.
|
|
*Name ______________________________________________________________
*Tribal Enrollment Number (found on your Enrollment Certificate) _____________
*Physical Address ____________________________________________________
*Mailing Address (if different) ___________________________________________
*Date of Birth ________________________________
*Circle Your Gender: Male Female
*Are you a member of any American Indian Nation other than the Lipan Apache Tribe of Texas?
No
Yes
*Your Signature ______________________________________ Date_____________
|
|
II. |
Current Contact Information:
*Phone Number _(_____)______-___________(home), _(_____)______-__________(cell)
*E-mail address, if applicable ______________________________________________
|
| __..__..__..__..__..__..__..__..__..__..__..__..__..__..
__..__..__..__..__..__..__..__..__..__..__..__..__..__.. |
|
|
|
III. |
Signature Block:
Please sign your name inside the Signature Block using a black
Sharpie Fine Point Permanent Marker or similar pen. Make sure
your signature fills up the entire block. Parents may sign for
minor children. Do not sign with an Ultra Fine Sharpie.
EXAMPLE: Signature fills entire block area
Tribal Vice-Chairman Robert Soto is processing the identification cards. Send completed form, photo and fee directly to him.
Please allow 3-4 weeks for processing.
Robert Soto
1913 Camellia
McAllen, TX 78501
|
