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Ribal Enrollment Application Applicant’s Full Name: Indian, Maiden, or other name used: Mailing Address: City: Phone: ( ) State: - Email: Applicant’s Birth date (mm/dd/yyyy): Social Security Number: Zip: / / / Birthplace: / Ancestor on base roll through whom enrollment rights are claimed: Name: Indian Tribe: 1. Relationship: Other: Is either of your parents enrolled as a member of another Tribe? YES NO YES NO Is the applicant a direct lineal descendant of a member of the Tr.

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