Ho Chunk Per Cap Loan Form PDF Details

Are you in need of a loan to help with day-to-day expenses? The Ho Chunk Nation offers a Per Cap Loan Form that is offered as part of their economic program. This loan form provides an excellent opportunity for tribal members who are in need of financial assistance to get the help they require quickly and securely. Here, you can learn more about the benefits associated with submitting your request for a per capita loan from the Ho Chunk Nation and get tips on how to complete the application process successfully.

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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Concentrate while completing this pdf. Make sure that each and every blank field is filled in properly.

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

It is possible to make errors while filling in your Per Capita Advance Policy, so be sure to look again before you'll finalize the form.

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