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DISTRIBUTION DEDUCTION POLICY/LIMIT WAIVER (The Tulalip Tribes)

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TDS-26778
DISTRIBUTION DEDUCTION POLICY/LIMIT WAIVER
POLICY REFERENCE: RESOLUTION 2018-274
TULALIP TRIBAL MEMBERSHIP LOAN PROGRAM
COMPLETE FORM AND PRESENT TO THE CASHIER’S WINDOW AT THE ADMIN. BUILDING
RETAIN A COPY FOR YOUR RECORDS
TRIBAL MEMBER NAME
TRIBAL ENROLLMENT NUMBER
T-
TRIBAL MEMBER POLICY WAIVER: I request that the Tulalip Tribes Finance Department waive
my rights to that portion of the Tribal Member Distribution Deductions Policy that limits the amount
of my available Tribal Member Distribution that I can pledge to qualify and repay Tribal Membership
Loans (“50% Rule”). I understand that this a voluntary waiver of Tribal Member Distribution
Deductions limits provided to me by the above referenced policy and that this waiver applies
to all membership and HERAP loans that I have with the Tribes.
Time stamped – This form must be time stamped by the Finance Cashier Window located on the rst
oor in the Tribal Government Administration Building.
I acknowledge I am the person authorized to sign this form and that I authorize the waiver of the
“50% Rule” identied in the above referenced policy.
DATE TRIBAL MEMBER SIGNATURE
DATE TRIBAL MEMBER PRINT NAME
POWER OF ATTORNEY USE IS NOT AUTHORIZED AND WILL NOT BE ACCEPTED
TO SECURE MEMBERSHIP LOANS OR AUTHORIZE POLICY WAIVERS.
MEMBER LOAN #:
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Date Application Received: ___________
Membership Emergency Loan Application
EMERGENCY TRIBAL LOAN APPLICATION | 2019.08
Name: _____________________________________________________________ T# ___________ DOB_____________
Address: ________________________________________ City: ______________________ State: _____Zip: __________
Phone #_______________________ Message #_______________________ E-Mail_______________________________
THIRD PARTY DOCUMENTATION REQUIRED FOR ALL EMERGENCY LOANS
□Natural Disaster _____________________________ Amount $ _______
1. Official third party documentation_________________________
□Loss of an Immediate Family Member (up to $1000.00)
(Parent, Sibling, Spouse, Child)
1. Official third party documentation_________________________
---------------------------------------
Once per 12-month period
□Essential utility shut off PAYABLE TO: ___________________________
1. Disconnection notice must reflect Applicant Name
2. Completed W-9 Form if not Snohomish PUD or City of Marysville
□Eviction Notice PAYABLE TO: _________________________________
1. Eviction notice
2. Copy of Lease Agreement
3. Completed W-9 Form
REPAYMENT Option
$___________Monthly Per Capita
$ __________ Monthly Senior Per Capita
$ __________ Bi-Monthly Elder Support
$ __________ Bi-Monthly Disability
$ __________ Bi-Weekly Payroll deduction Check: TTT TGO QCV
The Tulalip Membership Loan Policy includes a 9% interest per annum on all loans, the minimum required monthly payment per the
policy applies to Emergency Loans. By signing this application I attest the information I have provided is true and agree to the terms
of the Membership Loan Policy. I acknowledge this loan will be combined with any current loan and the pre-determined payment
schedule for a single loan payment.
□ Color copy of Tribal ID attached
_______________________________________________________ ________________________
Signature Date
POWER OF ATTORNEY WILL NOT BE ACCEPTED
FINANCE ONLY
ELIGIBILITY REVIEW
Monthly Distribution available amount
$________________
Loan Balance $________________________
Last Emergency Loan:
Utility _____/_____/_______
Eviction _____/_____/_______
□ Approved □ Disapproved
□ Issued within two business days
Emergency Loan amount $______________
Notes:_______________________________
____________________________________
____________________________________
____________________________________
____________________________________
Vendor ID: ___________________
□ New
Reviewed by: _________________________
2
nd
Review by: ________________________
Entered by: __________________________
TDS-30594 | Rev 08/19
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The Tulalip Tribes Application#: _______
6406 Marine Drive Membership Loan #: _____
Tulalip, WA 98271 Tulalip Tribal Number #: ____
1 | Page
_ ___ (initials)
TRIBAL MEMBERSHIP DISTRIBUTION LOAN PROGRAM
Tulalip Tribes
PROMISSORY NOTE
Principal Amount: ______________ Interest Rate: Nine Percent (9%) Note Date: _________
INTRODUCTION
For value received, I ______________________ also known as Tulalip Tribal Member
T-________ (“Borrower”), located at ______________________________________________
(provide physical and mailing address, if different) promises to pay to the Tulalip Tribes of
Washington (“Holder”) located at 6406 Marine Drive, Tulalip, WA 98271, the sum of
_____________________ ($ ) (“Loan Amount”) from the date hereon for a loan term of
twenty-two months (22 months), with simple interest thereon at the rate of Nine Percent (9%)
until the loan principal, interest and any applicable fees identified in the note are paid in full.
SECURITY
[ ] I acknowledge that this note is secured by my monthly Tribal Membership Distribution
(see Payments). I hereby pledge my distribution to secure the debt owed by me to the
Holder under this Promissory Note, which Holder may execute without further notice to
me in the event of my default (_________ Borrower Initial).
[ ] I acknowledge that along with this note I am executing a Financing Statement pledging
the security interest in the my Tribal Membership Distribution defined above and that the
Financing Statement will be recorded at the Tulalip Tribes Court until the debt associated
with the promissory note is paid in full. (_________ Borrower Initial)
PAYMENTS
I acknowledge a minimum monthly payment of $_______ per month which I authorize to be
deducted monthly from my Tribal Membership Distribution. I also acknowledge that I may elect
to pay more than the minimum monthly payment required by this note without prepayment
penalty and that any payment overages will be applied in the following priority: interest due at
the time of payment, applicable fees identified in this promissory note (i.e.: late / legal), and
then principal reduction until the loan is paid in full.
(CHOOSE ONE: SELECT ONE OF TWO OPTIONS PAYMENT OPTIONS - TRIBAL
MEMBER DEDUCTION OR PAYROLL DEDUCTION). Check and initial at end of
option selected.
The Tulalip Tribes Application#: _______
6406 Marine Drive Membership Loan #: _____
Tulalip, WA 98271 Tulalip Tribal Number #: ____
2 | Page
_ ___ (initials)
[ ] TRIBAL MEMBERSHIP DEDUCTION: I authorize the Finance
Department of the Tulalip government to deduct $___________ per month from
my _____________Tribal Membership Distribution account (INSERT ONE: Per
Capita / Senior Support / Elder Support or Disability Support) until the loan is
paid in full.
I understand the requested monthly deduction will continue even in the event that
my Tribal Membership Distribution status changes (i.e.: from “Disability
Support” to “Senior Support” ) until the balance of my loan is paid in full. I
understand that at any time, with 30 days’ notice to Finance but no more than two
times per year, I can amend the amount of my Per Capita deductions as long as it
does not go below $________ per month and the loan is paid in full within
twenty-two months (22) from initial disbursement. (_________, Borrower
Initials, this is deduction option is selected).
[ ] PAYROLL DEDUCTIONS: I authorize the following payroll
deduction: $________ per month until the loan is paid in full. I understand and
authorize Finance, in the event of employment separation, to automatically deduct
the monthly payments due on this note from my Tribal Member Distribution until
the loan is paid in full. (_________, Borrower Initials, this is deduction option
is selected).
Borrower to indicate employer by checking applicable entity below:
○ Tulalip Tribes Government
○ Tulalip Gaming Organization
○ Quil Ceda Village
o Pharmacy
o Salish Networks
I acknowledge that payments on this note are due on the 1st day of each month, with the first
payment due the second month from the date of loan disbursement.
I acknowledge that it is my responsibility to confirm that the correct monthly payments are
being deducted from my Tribal Membership Distribution (or payroll, as applicable) and
applied to my loan balance each month. I will notify the Finance Department immediately, no
more than three business days upon discovery, if payments are not correctly deducted as
instructed in this promissory note and any other related loan documentation.
I understand that this note is due upon my death, or can be assumed by my surviving tribal
spouse, and obligate my estate to the repayment of this debt prior to any distributions to heirs
(________ Borrower Initials).
The Tulalip Tribes Application#: _______
6406 Marine Drive Membership Loan #: _____
Tulalip, WA 98271 Tulalip Tribal Number #: ____
3 | Page
_ ___ (initials)
INTEREST
The interest rate of this note hereunder shall be a rate of nine percent (9%) simple interest,
calculated from the loan funding date through loan payoff.
DEFAULT
1) If any installment is not paid, when the installment becomes due, the whole sum of the loan
including both principal and interest with any applicable fees, are due and payable at once
without further notice.
2) A Notice of Default will be issued at such time that payments are 60 days outstanding per this
promissory note and the Borrower will have 30 days to cure the default.
3) Upon issuance of a Notice of Default, late fees of $20 per month will be assessed to the loan
until the default is cured.
4) In the event of default, Holder has no further obligations to Borrower and may take action
without further notice.
5) If this loan is defaulted in accordance to the terms specified above the Tulalip Tribes shall be
entitled to the Borrowers’ per capita, consistent with approved law and policies, and
applicable limits until all outstanding principal, fees and interest are paid in full.
GOVERNING LAW
All disputes shall be resolved exclusively according to Tulalip Tribal Law and heard by the
Tulalip Tribal Court. Nothing in this agreement shall constitute a waiver of sovereign immunity
of the Tulalip Tribes. Borrower shall pay all costs incurred by Holder in collecting sums due
under this Note after a default, including reasonable attorneys’ fees, costs, and related late fees,
whether or not suit is brought. If Borrower or Holder sues to enforce this Note or to obtain a
declaration of its rights, the prevailing party in any such proceeding shall be entitled to recover
its reasonable attorneys’ fees and costs incurred in the proceeding (including those incurred in
any bankruptcy proceeding or appeal) from the non-prevailing party.
ENTIRE AGREEMENT
The parties agree that this note and identified Exhibits represent the entire agreement between the
parties.
NO IMPLIED WAIVER
If Holder allows the borrower to break or ignore an obligation the Holder does not waive any future
right to require those or any other obligations to be fulfilled.
SEVERABILITY
If any part, or parts, or the application of any part of this note is held invalid, such holding shall not
affect the validity of the remaining parts of this note.
The Tulalip Tribes Application#: _______
6406 Marine Drive Membership Loan #: _____
Tulalip, WA 98271 Tulalip Tribal Number #: ____
4 | Page
_ ___ (initials)
POWER OF ATTORNEY NOT AUTHORIZED
The party executing this promissory note is the Tulalip Tribes member obligated to repay the debt, the
use of a Power of Attorney is not allowed by the Membership Loan Program.
Prior to signing this Promissory Note, I have read and agree to all the conditions and terms
mentioned above, and I understand that the Tulalip Tribes Reserves the right to garnish the full
allowable amount to pay off the outstanding debt including but not limited to all principal, and
interest.
I acknowledge that I have received a completed copy of this Promissory Note.
_______________________________ ________________________
Borrower’s Signature Date
_______________________________ ________________________
Print Name Date
Tribal Identification Number: T-
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The Tulalip Tribes Application#: _______
6406 Marine Drive Membership Loan #: _____
Tulalip, WA 98271 Tulalip Tribal Number #: ____
5 | Page
_ ___ (initials)
NOTARIZED SIGNATURE REQUIRED ONLY WHEN MAILING IN APPLICATION
State of Washington
County of Snohomish
Signed or attested before me on ______________, 2018 by
_______________________________________________,
___________________ Tribal Identification Number.
(Seal or stamp)
Print Notary Name _____________________________
My appointment expires _________________________
For Official use only:
BOD Approval date and Resolution or Directive #
Loan ID #:
Customer Number
Address:
Mailing Address if different:
Beginning Balance
Interest Rate:
Loan Type: Fixed
Period type: Month
Number of Periods: 60
Payment Amount:
AR Code:
Start Date:
NOTARIZED ATTACHMENT: (Required for mail-in forms)
M
aker’s Tribal ID No. ___________
Notary Attachment to Tribal Loan Promissory Note
Before me, the undersigned authority, personally appeared freely and voluntarily;
___________________________________________, hereinafter referred to as the applicant, is
known to me (or is satisfactorily proven) to be the person whose name is subscribed to within
this instrument, and I acknowledge that she/he executed the same for the purposes therein
contained.
Affix Stamp Here
________________________________
Applicant Signature
The above and foregoing sworn and subscribed to before me on this, the ________ day of
______________________, 20______.
_____________________________________
Notary Public Signature
Residing in the County of _________________________________,
in the State of __________________________________________.
My commission expires on this date _________________________.
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DISTRIBUTION DEDUCTION POLICYLIMIT WAIVER (The Tulalip Tribes)

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Completed 20 July 2020

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