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CHITIMACHA TRIBAL COURTS (Chitimacha Tribe of Louisiana)

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CHITIMACHA TRIBAL COURTS
IN RE: * PETITION FOR DISBURSEMENT
* OF FUNDS
* (Underage Qualified Tribal Member
* with Representation)
*
* CASE NUMBER:
* * * * * * * * * * * * * * * * *
NOW BEFORE the Court comes, , Petitioner as the
Representative on behalf of _ an Underage Qualified
Tribal Member in the above captioned matter, and alleges as follows;
1. That he/she (is) (is not) an enrolled member of the Chitimacha Tribe of Louisiana and is
presently residing at with
his/her current mailing address being .
2. That is an enrolled member of the Chitimacha Tribe
(Underage Qualified Tribal Member) of Louisiana, whose date of birth is ,
whose social security number is , and is currently residing at
, with his/her current mailing address being,
.
3. That pursuant to “Gaming Revenue Allocation Plan”, Section III (H)(2),
, is a qualified tribal member as defined in Section III (F)
and, he/she has reached the age of Eighteen (18) but has not reached the age of Twenty-
One(21), and is therefore recognized as an “Underage Qualified Tribal Member”.
4. Further, that pursuant to the Chitimacha Comprehensive Codes of Justice, Title VI,
Chapter 4, Section 413, jurisdiction over these matters is vested in the Chitimacha Tribal Court.
Therefore, he/she seeks disbursement of $ of the funds held in trust for
which currently total $ , for the following
reason(s):
.
(Attach separate sheet to continue basis for request along with all supporting
documentation for request)
5. Further, that $ of the funds have been previously disbursed pursuant to
the Order of this Court as rendered on .
6. Petitioner requests that this matter be scheduled for hearing.
WHEREFORE, Petitioner prays that this matter be
scheduled for hearing and following same that there be disbursement of the funds currently held
in trust for , in the amount of $ .
PETITIONER:
ADDRESS:
____________________________________
PHONE:
EMAIL ADDRESS:
CHITIMACHA TRIBAL COURTS
VERIFICATION - PETITION FOR
DISBURSEMENT OF FUNDS
BEFORE ME, the undersigned, personally came and appeared,
, who, after being duly sworn, did depose and say that he/she is the
mover in the foregoing petition, and that all of the facts contained therein are true and correct to
the best of his/her knowledge and belief.
MOVER/PETITIONER
SWORN TO AND SUBSCRIBED before me this day of ,
20 .
NOTARY, OR;
TRIBAL COURT CLERK
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CHITIMACHA TRIBAL COURTS (Chitimacha Tribe of Louisiana)

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Completed 20 July 2020

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