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About Siletz news / (Siletz, OR) 199?-current | View Entire Issue (Jan. 1, 2011)
Tribal history book available by mail Siletz Tribal History Book Request Form (One per enrolled Tribal member) First Name ________________________ Last Name ________________________ The news Siletz Tribal history book, The People Are Dancing Again, can be mailed to those Tribal members who did n6t receive a book at one of the November book distributions. To receive a book, complete and submit a book request form to: ATT: Tribal History Book Confederated Tribes of Siletz Indians P.O. Box 549 Siletz, OR 97380-0549 Book request forms (right) are avail able online on the Tribe’s website - w^vw.csti.nsn.us - and in this month’s area office newsletters. The form states that you must submit a photocopy of your picture identifica tion or a Certification of Indian Blood Degree (CIB). To obtain a CIB, contact Enrollment Department staff toll-free at 800-922-1399, ext. 1258, or direct at 541-444-8258. Acceptable photo identification includes Tribal photo enrollment identifi cation, a driver’s license, a state identifica tion card, a student body card, passport, Armed Forces pass, firearms license or other government-issued ID. In the event a Tribal member (adult or minor) has no photo identification, another person who does have photo ID can sign the form in front of the notary attesting that the Tribal member is the person named on the form based on the fact that they personally know that Tribal member. If you have any questions about this process, please contact Assistant Gen eral Manager Bonnie Petersen toll-free at 800-922-1399, ext. 1210, or direct at 541-444-8210; or via e-mail at bonniep@ ctsi.nsn.us. 8 . • Siletz News M.I. ________ Roll # __________ If you are applying on behalf of a Tribal member who is a minor, please list minor’s name here: First Name ________________________ Last Name ________________________ M.I. ________ Roll # __________ Street Address ___________________________________________________________________________________________ Mailing Address _______________________________________________ City ___________________________________________ [ ] This is a new address State ZIP Phone Number(s) ______________________________________ E-mail Address ___________________ I am requesting a copy of the Siletz Tribe’s history book, The People Are Dancing Again. I understand that each Tribal member is entitled to one free book. I confirm by my signed and dated signature below that I am the person listed above and am an enrolled Tribal member or that I am signing on behalf of a minor enrolled Tribal member who is my legal dependent. Return form along with a photocopy of picture identification or Tribal CIB or if you do not have picture identification, sign and date form in the presence of a Notary Public (see below) Signature: _____________________________________________ Date: __________________________________________________ INDIVIDUAL ACKNOWLEDGEMENT STATE OF ________________________ ) COUNTY OF ______________________ ) On the_____ day of_______________ , 201__ ,____________________________________ , personally appeared before me: ____________ whom I know personally. ____________ whose identity I verified on the basis of______________________________________ a credible witness who produced their photographic ID and who verified on oath or affirmation that the individual appearing before the notary public as the signer of the document is the person named in the document. ____________ whose identity I verified on the basis of________________________________________ a credible witness who produced their photographic ID and who verified on oath or affirmation that they are completing this form on behalf of a Tribal member minor. January ZOl.Ku Notary Public My Commission expires:
