LOVELOCK PAIUTE TRIBE
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Enrollment Application
*
Indicates required field
Name
*
First
Last
SSN:
*
Phone Number
*
Address
*
city
*
State
*
zip
*
Gender
*
Male
Female
Bi-Nary
Place of Birth
*
My Degree of Blood
*
My Degree of Other Blood
*
Is The Applicant Eligible form Another Tribe(if not sure please answer yes)
*
yes
no
Not Sure
Not Sure, please explain
*
Are you allotted any land or hold on assignment on any other Indian Reservation?
*
Yes
No
N/A
Lovelock Paiute Tribe Ancestry Chart
Self
Name
*
First
Last
Roll#
*
Tribe & Degree
*
Total Blood Degree
*
D.O.B mm/dd/yyyy
*
Parents
Name
*
First
Last
[object Object]
Roll #
*
Tribe & Degree
*
Total Blood Degree
*
D.O.B mm/dd/yyyy
*
Name
*
First
Last
[object Object]
Roll #
*
Tribe & Degree
*
Total Blood Degree
*
D.O.B mm/dd/yyyy
*
Grand Parents
Name
*
First
Last
Roll #
*
Tribe & Degree
*
Total Blood Degree
*
Name
*
First
Last
Roll #
*
Tribe & Degree
*
Total Blood Degree
*
Name
*
First
Last
Roll #
*
Tribe & Degree
*
Total Blood Degree
*
Name
*
First
Last
Roll #
*
Tribe & Degree
*
Total Blood Degree
*
Great Grand Parents
Name
*
First
Last
Roll #
*
Tribe & Degree
*
Total Blood Degree
*
Name
*
First
Last
Roll #
*
Tribe & Degree
*
Total Blood Degree
*
Name
*
First
Last
Roll #
*
Tribe & Degree
*
Total Blood Degree
*
Name
*
First
Last
Roll #
*
Tribe & Degree
*
Total Blood Degree
*
Name
*
First
Last
Roll #
*
Tribe & Degree
*
Total Blood Degree
*
Name
*
First
Last
Roll #
*
Tribe & Degree
*
Total Blood Degree
*
Name
*
First
Last
Roll #
*
Tribe & Degree
*
Total Blood Degree
*
Name
*
First
Last
Roll #
*
Tribe & Degree
*
Total Blood Degree
*
Family Information
Please complete this form first. Pl
ease list all family members not enrolled in the Lovelock Paiute Tribe, regardless of age. Please email information to
enrollment@lovelocktribe.com
if more members are in your family.
Name
*
First
Last
Sex
*
Male
Female
Bi-Nary
Date of Birth mm/dd/yyyy
*
Name
*
First
Last
Sex
*
Male
Female
Bi-Nary
Date Of Birth mm/dd/yyyy
*
Name
*
First
Last
Sex
*
Male
Female
Bi-Nary
Date Of Birth mm/dd/yyyy
*
Name
*
First
Last
Sex
*
Male
Female
Bi-Nary
Date Of Birth mm/dd/yyyy
*
Name
*
First
Last
Sex
*
Male
Female
Bi-Nary
Date Of Birth mm/dd/yyyy
*
By summitting this form you agree that all your information is correct and true to the best of your knowledge. Any and all people listed on this application are direct descendants of the Lovelock Paiute Tribe according to Article II- Membership of the Lovelock Paiute Tribe Constitution and Bylaws.
Person filling out form
*
Self
Parent / Legal Guardian
Sponsor of a person on duty in U.S. Armed Forces
Supporting Doc.( Birth Certificate, SSN Card)
*
Max file size: 20MB
Supporting Doc(birth certificate , ssn card)
*
Max file size: 20MB
Submit
Home
Departments
Tribal Council: Administration
Tribal Court
Law Enforcement
Housing
Social Services: ICWA/GA
Enrollment
Youth Program
Health Services
Tribal Programs
Contact Us
