Per-Capita Address Change Form

Per-Capita

Address Change Form

All address changes must be in by the 3rd Friday of the month in order to receive the following months check.

Did you know you can use the SmartSheet App to submit this application?

If you encounter issues submitting this application through your mobile browser, download the SmartSheet app (it's free) or use a desktop or laptop computer. https://apps.apple.com/us/app/smartsheet-teams-projects/id568421135 https://play.google.com/store/apps/details?id=com.smartsheet.android&hl=en_US&gl=US If you want a copy of your submission, remember to check the box at the end of the application.

Please select one of the following:*

Parent/Guardian

Self

Last Name:*

First Name:*

MI:*

Suffix:

Date of Birth:*

Address:*

City*

State:*

Zip Code:*

Telephone Number:*

Email Address:*

I am:*

Native

Non Native

Tribal ID Number:*

Household Information:

How many Puyallup Tribal Children, 17 years old and younger, reside in your household?*

Please list all Puyallup Tribal Children 17 and under that reside in your household that you have full custody or guardianship of. Custody papers are also required to change an address for a minor. Please do not list any children that do not live with you.

Child First Name:*

Last Name:*

MI:

Date of Birth:*

Social Security Number:*

Relationship to child:*

Child's Tribal ID Number:*

Child's First Name:*

Last Name:*

MI:

Date of Birth:*

Social Security Number:*

Relationship to child:*

Child's Tribal ID Number:*

Child's First Name:*

Last Name:*

MI:

Date of Birth:*

Social Security Number:*

Relationship to child:*

Child's Tribal ID Number:*

Child's First Name:*

Last Name:*

MI:

Date of Birth:*

Social Security Number:*

Relationship to child:*

Child's Tribal ID Number:*

Child's First Name:*

Last Name:*

MI:

Date of Birth:*

Social Security Number:*

Relationship to child:*

Child's Tribal ID Number:*

Child's First Name:*

Last Name:*

MI:

Date of Birth:*

Social Security Number:*

Relationship to child:*

Child's Tribal ID Number:*

Child's First Name:*

Last Name:*

MI:

Date of Birth:*

Social Security Number:*

Relationship to child:

Child's Tribal ID Number:*

Child's First Name:*

Last Name:*

MI:

Date of Birth:*

Social Security Number:*

Relationship to child:*

Child's Tribal ID Number:*

Do you have another child to add?*

Yes

Child's First Name:*

Last Name:*

MI:

Date of Birth:*

Social Security Number:*

Relationship to child:*

Child's Tribal ID Number:*

Do you have another child to add?*

Yes

Child's First Name:*

Last Name:*

MI:*

Date of Birth:*

Social Security Number:*

Relationship to child:*

Child's Tribal ID Number:*

Custody Paperwork File Upload

Custody papers are also required to change an address for a minor.

Drag and drop files here or

Applicant Full Name:*

Parent/Guardian Full Name:*

Today's Date:*

I certify that all the information provided herein is accurate and complete to the best of my knowledge. By signing this application, I agree to comply with the terms, policies and procedures.*

If you have any questions, please email PerCapita@PuyallupTribe-nsn.gov.

Send me a copy of my responses

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