Application for Duplicate CDIB card
(800) 522-6170 (580) 924-8280 ext. 4030
Duplicate CDIB needed for:
Name_____________________________________________________
First Middle Last Maiden
Date of Birth: _________________________
Social Security Number: _______________________
(must provide copy of card)
Telephone Number: ___________________________
Tribe(s): _________________________ Email:____________________________
Mailing Address _____________________________________________________
_____________________________________________________
City State Zip code County
Physical Address (if different): ____________________________________________
_____________________________________________________
City State Zip code County
_____________________________
Date
________________________________________
Si
gnature of applicant or guardian of applicant
Please return this application to:
Choctaw Nation of Oklahoma
Attn: Tribal Membership
PO Box 1210
Fax: (580) 920-7001
cdib-membership@choctawnation.com
Durant, OK 74702-1210
Veteran/Active Duty? Yes No (circle one)
If yes, please provide a copy of your DD-214 or Active Duty/Retired ID card
Application must be signed before a DUPLICATE CDIB card can be issued
All applicants must provide a copy of their state full form birth certificate.
This is required for all DUPLICATE CDIB cards.
When you originally applied for a CDIB, copies of these documents were not kept on file.
click to sign
signature
click to edit
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