The Tulalip Tribes Application#: _______
6406 Marine Drive Membership Loan #: _____
Tulalip, WA 98271 Tulalip Tribal Number #: ____
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_ ___ (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
Borrower to indicate employer by checking applicable entity below:
○ Tulalip Tribes Government
○ Tulalip Gaming Organization
○ Quil Ceda Village
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).