The Ho Chunk Per Cap Loan form serves as an application for Tribal members of the Ho-Chunk Nation seeking an advance on their Per Capita distributions, with a maximum requestable amount of $1,000. This form requires thorough personal information, including the applicant's name, contact details, and social security number, and emphasizes the need for honesty, as any false information may render the applicant ineligible for future advances. It is crucial to note that the form itself does not update the applicant's address with the Enrollment Office, which remains the applicant's responsibility.
For those interested in applying, ensure the form is completed with accurate and current information. Click the button below to start your application process.
Download PDF
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.
| Question | Answer |
|---|---|
| Form Name | Ho Chunk Per Cap Loan Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | ho chunk nation per capita payments 2020, ho chunk nation treasury, ho chunk nation forms, ho chunk per cap advance |
PER CAPITA ADVANCE APPLICATION
PLEASE PRINT CLEARLY **E LDERS P LEASE C HECK T HIS B OX
CURRENT ENROLLMENT ADDRESS
ENROLLMENT NUMBER (Last 4 Digits)
(Area Code) DAY TIME PHONE NUMBER
AMOUNT REQUESTING (MAXIMUM $1,000)
SOCIAL SECURITY NUMBER (Last 4 digits)
PREFERRED CONTACT METHOD (PHONE or
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 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.
The undersigned hereby gives the 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
***Applications can be faxed to mailed to the address listed below, dropped off at the HCN Department of Treasury or to:
Date Received in Treasury:
P O Box 640 Black River Falls WI 54615(715) ~ Fax (715)
Per Capita Advance Policy & Application
PER CAPITA PLEDGE
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 Distributions should
this advance or any prior tribal advances become delinquent. I understand that by signing this Agreement I am giving permission to the Nation to withhold any and all amounts due to them. Any amount of the Distribution, which exceeds the balance, will be returned to
State of: ________________________________________ County of: ________________________________________
Signed or attested before me on this _______ day of _____________________, 20 _____.
Per Capita Advance Policy & Application
Whenever you would like to fill out ho chunk nation forms, there's no need to install any kind of applications - simply try using our online PDF editor. To make our editor better and less complicated to use, we continuously come up with new features, considering suggestions from our users. To get started on your journey, go through these simple steps:
Step 1: Hit the "Get Form" button above. It'll open our editor so that you could begin completing your form.
Step 2: Using our advanced PDF editor, it is possible to accomplish more than merely complete blanks. Express yourself and make your documents seem perfect with custom textual content added in, or modify the original input to perfection - all that supported by the capability to add your own photos and sign the PDF off.
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:
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.
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.
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.
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.
Step 3: After double-checking the fields and details, hit "Done" and you're good to go! Grab your ho chunk nation forms once you sign up for a free trial. Instantly gain access to the pdf document inside your personal account page, together with any modifications and adjustments being all saved! We don't share the information that you provide when completing forms at our site.
