Creek Nation Tribal Driveway Form – Fill Out and Use This PDF

Instructions for completing the Driveway Repair Application

This application is for the maintenance of accessible driveways for Muscogee (Creek) Nation enrolled tribal members and property owners, who reside within the territorial jurisdiction of the Muscogee (Creek) Nation. This program addresses the needs of the Muscogee (Creek) Nation citizen’s, to repair or replace existing driveways. The selection of eligible families/ individual’s to participate in this program will be made by the Tribal Driveway’s program manager. Selection shall be based on all the factor’s contained in the application, an on-site inspection of the land/property, and the amount of funding currently available to the Tribal Driveways.

Individual’s wishing to apply for assistance should submit the foregoing application to:

Muscogee (Creek) Nation

Attn: Tribal Driveways Program

P.O. Box 580

Okmulgee, OK 74447

PLEASE RETURN COPIES OF THE FOLLOWING DOCUMENTS ALONG WITH YOUR APPLICATION:

1)Copy of Creek Citizenship Card

2)Copy of Warranty Deed to property in your name

3)Copy of Driver’s License (or Oklahoma ID)

Failure to include any of the above listed information will delay the application process and the applicant will be notified by mail. Once inspected, applicant’s will receive an on-site inspection letter by mail.

*ELIGIBILITY: Will be limited to no more than one (1) service every four (4) year’s for the property seeking services. Tribal Driveway’s will do the repair work on driveway’s at no charge. Each project will be limited.

*PRIORITY: Will be given to the elderly, applicant’s who are suffering from a severe health problem, handicap permanent disability and driveway’s that are rapidly deteriorating.

SERVICES DO NO T INCLUD E: LANDSCAPE, BLA CK TO P, CO NCRETE, BR IDGES OR BU ILDING NEW DRIVEW AYS. YOU M UST O W N AND LIVE O N THE PROPERTY AND HAVE AN EXISTING DRIVEW AY TO BE ELIGIBLE.

If eligible, everyone will be served. Please be patient and we will get to you as soon as we can. The waiting period for this program could be approximately six (6) months to a year.

MUSCOGEE (CREEK) NATION

TRIBAL DRIVEWAY REPAIR APPLICATION

NAME:_________________________________________________________________

LastFirstMI

ADDRESS:_______________________________________COUNTY:_____________

______________________________________________________________

City	State	Zip Code
HOME PH#__________________WK#___________________CELL#_____________
DATE OF BIRTH:_____________________	AGE:_________

CREEK ROLL NUMBER:_________________________________

(Include a copy of Enrollment Citizenship Card)

MARITAL STATUS:______MARRIED _____ SINGLE _____ WIDOWED

SPOUSE’S NAME:___________________________________________________

LastFirstMI

SPOUSE’S DATE OF BIRTH:_____________________ AGE:____________

FAMILY INFORMATION

List all other persons living in the household on a permanent basis, starting with the eldest person:

NAME:AGERELATIONSHIP

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

If you need additional space, please use the back of this page.

MEDICAL INFORMATION

Does anyone in your family who was listed as a permanent resident on page 1 of this application suffer from a severe health problem, handicap or permanent disability? If yes, please provide the name, relationship and brief description of said problem and attach certified documentation (Doctor’s statement describing the ailment) to this application.

_______________________________________________________________________________

______________________________________________________________________________

LAND INFORMATION

Do you own the property on which you need work performed on? _________________________

Do you presently live on the below described property? _________________________________

Please state the legal description of the property. (Please include a copy of the deed.)

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Please give directions and general location to your home or area where work is to be performed:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Describe briefly the work that you are requesting. (Material only, materials, equipment and labor, gravel, etc.) ____________________________________________________________________

______________________________________________________________________________

What is the approximate length of the driveway? _______________________________________

APPLICANT’S CERTIFICATION:

I CERTIFIED THAT ALL OF THE ANSWERS GIVEN ARE TRUE, COMPLETE, AND CORRECT TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT ANY FALSE INFORMATION GIVEN WILL CAUSE AUTOMATIC DENIAL OF MY APPLICATION.

________________________________	_____________________
Applicant’s Signature	Date
________________________________	_____________________
Spouse’s Signature	Date

TREE LIMB AGREEMENT

In some instances, the removal of branches, limbs and/or an entire tree is necessary due to it’s interference in the widening, graveling and clearing of ditches for repair or replacement services. The purpose of the removal is to allow easier access for equipment and to allow extra sunlight to keep the driveway dry.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

The above will need to be removed by either the landowner (the person requesting driveway repair services) or the Tribal Driveways Program will provide removal upon the signature of the landowner.

If an objection is made to removal, please state the objection below.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Because of the above reason (s), I object to the removal of branches, limbs and/or an entire tree so that the requested driveway repair can be completed.

___________________________	__________________________
Applicant’s Signature	Date

I do not object to the removal of branches, limbs and/or an entire tree so that the requested driveway repair can be completed.

___________________________	__________________________
Applicant’s Signature	Date
___________________________________	__________________________
Tribal Driveways Representative Signature	Date