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Get Winnebago Tribe Of Nebraska Stimulus 2017

Winnebago Tribe of Nebraska Address Verification Form July 2014 Stimulus P. O. Box 687 Winnebago NE 68071 Distribution July 22 2014 Tuesday Blackhawk Community Center Time 8 30-4 30 PLEASE PRINT LEGIBLY Faxes will not be accepted. All incomplete forms will be returned to sender. Enrollment 383-U0 Leave blank if unknown Name First M. I. Last Jr. Sr. III Address Street City State Zip SSN XXX-XX- Telephone DOB AGE As an Enrolled member of the Winnebago Tribe of Nebraska I understand that this Stimulus payment is considered a gift from the Winnebago Tribe of Nebraska and not considered taxable. If you are a legal Conservator Power of Attorney or Guardian of another tribal member A copy of court documents MUST BE provided in order to pick up that individuals check. Checks will not be reissued after January 22 2015. Children under the age of 18 will go into a Minor Trust Fund Account until the age of 18 and have completed their H. S* Diploma or GED. Do not fill this form out for Minor s. I ACCEPT OR DECLINE the July 2014 Stimulus payment. Circle one Member Signature FOR NOTARY PUBLIC USE ONLY Sworn to and subscribed to before me this day of 20. SEAL Notary Public Signature Commission Expiration Date THIS FORM MUST BE NOTARIZED BY A NOTARY PUBLIC FOR OFFICE USE ONLY DATE REC D INITIAL Circle one PICKED UP MAILED. Enrollment 383-U0 Leave blank if unknown Name First M. I. Last Jr. Sr. III Address Street City State Zip SSN XXX-XX- Telephone DOB AGE As an Enrolled member of the Winnebago Tribe of Nebraska I understand that this Stimulus payment is considered a gift from the Winnebago Tribe of Nebraska and not considered taxable. If you are a legal Conservator Power of Attorney or Guardian of another tribal member A copy of court documents MUST BE provided in order to pick up that individuals check. If you are a legal Conservator Power of Attorney or Guardian of another tribal member A copy of court documents MUST BE provided in order to pick up that individuals check. Checks will not be reissued after January 22 2015. Children under the age of 18 will go into a Minor Trust Fund Account until the age of 18 and have completed their H. Checks will not be reissued after January 22 2015. Children under the age of 18 will go into a Minor Trust Fund Account until the age of 18 and have completed their H. S* Diploma or GED. Do not fill this form out for Minor s. I ACCEPT OR DECLINE the July 2014 Stimulus payment. S* Diploma or GED. Do not fill this form out for Minor s. I ACCEPT OR DECLINE the July 2014 Stimulus payment. Circle one Member Signature FOR NOTARY PUBLIC USE ONLY Sworn to and subscribed to before me this day of 20. Circle one Member Signature FOR NOTARY PUBLIC USE ONLY Sworn to and subscribed to before me this day of 20. SEAL Notary Public Signature Commission Expiration Date THIS FORM MUST BE NOTARIZED BY A NOTARY PUBLIC FOR OFFICE USE ONLY DATE REC D INITIAL Circle one PICKED UP MAILED. Enrollment 383-U0 Leave blank if unknown Name First M. I. Last Jr. Sr. III Address Street City State Zip SSN XXX-XX- Telephone DOB AGE As an Enrolled member of the Winnebago Tribe of Nebraska I understand that this Stimulus payment is considered a gift from the Winnebago Tribe of Nebraska and not considered taxable. If you are a legal Conservator Power of Attorney or Guardian of another tribal member A copy of court documents MUST BE provided in order to pick up that individuals check. Checks will not be reissued after January 22 2015. Children under the age of 18 will go into a Minor Trust Fund Account until the age of 18 and have completed their H.

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