Ho Chunk Per Cap Loan Form PDF Details

Navigating financial assistance through tribal policies is an essential aspect for members of the Ho-Chunk Nation, facilitated by instruments like the Ho Chunk Per Cap Loan form. This crucial document serves as an application for those seeking a Per Capita Advance, offering a lifeline in times of need with a maximum request amount of $1,000. It is imperative that applicants provide their information accurately, including their name, current enrollment address, Ho-Chunk enrollment number, and the last four digits of their social security number, alongside contact details to ensure efficient communication. The form stipulates that advances will be distributed following the member's usual Per Capita disbursement method, be it manual check or direct deposit. Additionally, it clarifies that completing this application will not update the applicant's address on record nor fulfill the Annual Address Verification requirement for Per Capita disbursements, underscoring the responsibility of members to notify the Enrollment Office of any address changes. An essential part of the process involves the signing of the Ho-Chunk Nation Waiver where the member grants permission for information verification, acknowledging the importance of honesty and the implications of providing false information. Moreover, the Per Capita Pledge Agreement outlines the terms of collateral against future Per Capita Distributions for the advance received, illustrating a comprehensive approach to tribal financial assistance while ensuring accountability and understanding of the terms among the Ho-Chunk Nation members.

QuestionAnswer
Form NameHo Chunk Per Cap Loan Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesho chunk nation per capita payments 2020, ho chunk nation treasury, ho chunk nation forms, ho chunk per cap advance

Form Preview Example

HO-CHUNK NATION

PER CAPITA ADVANCE APPLICATION

PLEASE PRINT CLEARLY **ELDERS PLEASE CHECK THIS BOX

APPLICANTS NAME

CURRENT ENROLLMENT ADDRESS

CITY

STATE

ZIP

HO-CHUNK ENROLLMENT NUMBER (Last 4 Digits)

(Area Code) DAY TIME PHONE NUMBER

DATE of BIRTH

$

 

 

 

 

 

AMOUNT REQUESTING (MAXIMUM $1,000)

SOCIAL SECURITY NUMBER (Last 4 digits)

 

 

 

EMAIL ADDRESS

PREFERRED CONTACT METHOD (PHONE or E-Mail)

PLEASE NOTE: All Per Capita Advances will be disbursed in the same manner that the Tribal member receives their quarterly Per Capita distribution (i.e., manual check or direct deposit).

***Pursuant to Section 7 of the Ho-Chunk Nation amended and restated PER CAPITA DISTRIBUTION ORDINANCE, this application DOES NOT change your Address with Enrollment nor does it satisfy your Annual Address Verification with Enrollment for your quarterly Per Capita disbursements. Members shall be responsible for providing address changes to the Enrollment Office as they occur.

HO-CHUNK NATION WAIVER

The undersigned hereby gives the Ho-Chunk Nation permission to verify the information on this application. Upon signing, I certify that I have read and understand the terms of the Tribal Advance Policy. I understand that any false information or dishonesty may result in ineligibility to receive a Tribal Advance now and in the future.

SIGNATURE OF MEMBER

 

DATE

 

 

 

 

***Applications can be faxed to (715)284-7887, mailed to the address listed below, dropped off at the HCN Department of Treasury or e-mailed to: TOB.Loans@Ho-Chunk.com

*********************************** For Office Use Only ***********************************

Date Received in Treasury:

P O Box 640 Black River Falls WI 54615(715) 284-1778 ~ Fax (715) 284-7887

Per Capita Advance Policy & Application

Page 5 of 6

HO-CHUNK NATION

PER CAPITA PLEDGE

AGREEMENT

I,

 

upon receipt of an advance from the Ho-

 

(Please print First, MI, Last Name)

Chunk Nation, do hereby pledge as collateral any and all future Per-Capita Distributions should

this advance or any prior tribal advances become delinquent. I understand that by signing this Agreement I am giving permission to the Ho-Chunk Nation to withhold any and all amounts due to them. Any amount of the Per-Capita Distribution, which exceeds the balance, will be returned to

me.

 

 

Signed this

_ day of

,

MEMBER SIGNATURE

State of: ________________________________________ County of: ________________________________________

Signed or attested before me on this _______ day of _____________________, 20 _____.

NOTARIZED BY

COMMISSION EXPIRATION

Per Capita Advance Policy & Application

Page 6 of 6

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1. To begin with, once filling out the ho chunk nation forms, start out with the page that includes the following fields:

Step number 1 of filling in ho chunk per cap advance

2. After filling out this part, go on to the next part and fill out the essential details in all these blank fields - The undersigned hereby gives the, DATE, Applications can be faxed to, For Office Use Only, Date Received in Treasury, P O Box Black River Falls WI, Per Capita Advance Policy, and Page of.

For Office Use Only, Page  of, and Date Received in Treasury of ho chunk per cap advance

3. The next part is normally fairly straightforward, Please print First MI Last Name, upon receipt of an advance from, Chunk Nation do hereby pledge as, this advance or any prior tribal, Agreement I am giving permission, them Any amount of the PerCapita, Signed this, day of, MEMBER SIGNATURE, and State of County of - all of these form fields needs to be filled out here.

ho chunk per cap advance completion process outlined (portion 3)

4. The form's fourth section arrives with all of the following form blanks to consider: Signed or attested before me on, NOTARIZED BY, COMMISSION EXPIRATION, Per Capita Advance Policy, and Page of.

Completing section 4 in ho chunk per cap advance

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