Blackfeet Enrollment – Fill Out and Use This PDF

BLACKFEET TRIBE

ENROLLMENT/PER CAPITA DEPARTMENT

P.O.BOX 850

BROWNING, MONTANA 59417

PH: (406) 338-3533 * FAX: (406) 338-5233

ADDRESS CHANGE FORM

DATE: _________________

Dear Enrolled Blackfeet Tribal Member,

It is important that you update your mailing address with the Blackfeet Enrollment/Per Capita Department on a regular basis. Please be advised that this office needs this information by November 15th of each year to ensure accurate delivery of your annual Per Capita payment. Remember to include your minor children on this form. Adults 18 years & older must fill out a separate form that includes their children.

Due to our policy and procedures, your SIGNATURE must be NOTARIZED before we can accept this form. Please mail this form to the above address. (Faxed requests can be accepted if properly notarized)

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PLEASE PRINT THE INFORMATION BELOW

NAME’S OF MINOR CHILDREN, ENROLLMENT #’S AND/OR D.O.B.: ____________________________________________

__________________________________________________________________________________________________

SIGNATURE: __________________________________ SPOUSE: _____________________________________

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-NOTARY PUBLIC-

Appeared, subscribed and sworn before me, on this ____________________ day of _________________________, 20____________