Fillable Mailing Address: On Reservation Email Address: Off Reservation (Santa Rosa Band of Cahuilla Indians)

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Mailing Address: On Reservation Email Address: Off Reservation (Santa Rosa Band of Cahuilla Indians)

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The Mailing Address: On Reservation Email Address: Off Reservation (Santa Rosa Band of Cahuilla Indians) form is 1 page long and contains:

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  • 17 check-boxes
  • 20 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Santa Rosa Band of Cahuilla Indians

BROWSE SANTA ROSA BAND OF CAHUILLA INDIANS (CA) FORMS

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Tribal Home AMIHA Home Emergency Elder Disabled
Substandard
Name: Phone Number:
Mailing Address: On Reservation
Email Address: Off Reservation
Tribal Member 18 yrs. or older Quotes Denial Letter
Y N
(If so, please provide date and amount)
What type of housing assistance are you requesting for? Amount requesting for?
Plumbing Electrical Septic Structural Leak Other:
Signature:
Waiver:
Date:
HOUSING ASSISTANCE APPLICATION
Waiver: I understand that if I am approved for housing assistance, I may choose to have the work completed by a non-licensed laborer,
however the Santa Rosa Band of Cahuilla Indians will not guarantee the work and therefore will not be held liable or responsible for future
repairs on the above request. Please note that all receipts are due 2 weeks after cashing the check.
Please note until a minimum of (1) quote is received by the applicant, the SRHC will not be able to process your request.
Has applicant received housing assistance within calendar year?
* If requesting for tribal funds for AMIHA home, denial letter of MEPA or NAHASDA funds will need to be submitted with application.
Please describe in detail of repairs and or replacements that are needed.
Date:
(Please make sure to check below all that apply.)
Amount:
SRHC-HAA-2017
Please check all that apply:
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Mailing Address: On Reservation Email Address: Off Reservation (Santa Rosa Band of Cahuilla Indians)

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Completed 27 January 2021

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