LOVELOCK PAIUTE TRIBE
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Housing Application
*
Indicates required field
Name
*
First
Last
Street Address(P.O. Box)
*
City
*
State
*
Zip
*
Phone Number
*
Have you ever participated in a Lovelock Paiute Tribe housing program?
*
yes
no
Family Composition
Name
*
First
Last
Relationship
*
Self
Mother
Father
Brother
Sister
Niece
Nephew
D.O.B mm//dd/yyyy
*
SSN:
*
Name
*
First
Last
Relationship
*
Self
Mother
Father
Brother
Sister
Niece
Nephew
D.O.B mm//dd/yyyy
*
SSN:
*
Name
*
First
Last
Relationship
*
Self
Mother
Father
Brother
Sister
Niece
Nephew
D.O.B mm//dd/yyyy
*
SSN:
*
Name
*
First
Last
Relationship
*
Self
Mother
Father
Brother
Sister
Niece
Nephew
D.O.B mm//dd/yyyy
*
SSN:
*
Name
*
First
Last
Select One
*
Self
Mother
Father
Brother
Sister
Niece
Nephew
D.O.B mm//dd/yyyy
*
SSN:
*
Name
*
First
Last
Relationship
*
Self
Mother
Father
Brother
Sister
Niece
Nephew
D.O.B mm//dd/yyyy
*
SSN:
*
Name
*
First
Last
Relationship
*
Self
Mother
Father
Bother
Sister
Niece
Nephew
D.O.B mm//dd/yyyy
*
SSN:
*
Name
*
First
Last
Relationship
*
Self
Mother
Father
Brother
Sister
Niece
Nephew
D.O.B mm//dd/yyyy
*
SSN:
*
* SSN is not required for any family members that are 6 year or younger*
Are you an enrolled member of the LPT ?
*
Yes
No
Are you or your spouse a person with a disability ?
*
Yes
No
Are any of your family members with a disability living in the home ?
*
Yes
No
Yes: which member
*
Family Income
Name
*
First
Last
Employer Information
*
Line 1
Line 2
City
State
Zip Code
Country
Rate Per Hour
*
Hour Per Week
*
Name
*
First
Last
Employer Information
*
Line 1
Line 2
City
State
Zip Code
Country
Rate Per Hour
*
Hours Per Week
*
Name
*
First
Last
Employer Information
*
Line 1
Line 2
City
State
Zip Code
Country
Rate Per Hour
*
Hour Per Week
*
Name
*
First
Last
Employer Information
*
Line 1
Line 2
City
State
Zip Code
Country
Rate Per Hour
*
Hours Per Week
*
Other Income
Source
*
TANF
Social Security
S.S.I
Unemployment
Pension
Leases
Own Business
Other
monthly Income
*
Source
*
TANF
Social Security
S.S.I
Unemployment
Pension
Leases
Own Business
Other
monthly Income
*
Source
*
TANF
Social Security
S.S.I
Unemployment
Pension
Leases
Own Business
Other
monthly Income
*
Other source of income includes but not limited to: Alimony, Relief, Service Allotment, Assistance From Relatives, Payments From Foster Children, Or any other regular source of income
Total Year Income
*
Upload Documents
*
Max file size: 20MB
*
Please attach IRS 1040 and most recent pay stubs for all applicable family member.
Housing Conditions and Renovation Needs:
*
*
I understand that this application is not a contract and is not binding in any manner. I hereby authorize the Lovelock Paiute Tribe to obtain any and all information necessary for the purpose of verifying the statement above. I also understand that it is my responsibility to inform the Tribe in there is any changes to my family status along with reporting said changes to corresponding department. By submitting this form you agree.
Submit
Home
Departments
Tribal Council: Administration
>
News Letter
Tribal Court
Law Enforcement
Housing
Social Services: ICWA/GA
Enrollment
Youth Program
Health Services
Tribal Programs
Contact Us