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SALT RIVER PIMA-MARICOPA INDIAN COMMUNITY (Salt River Pima-Maricopa Indian Community)

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SALT RIVER
PIMA-MARICOPA INDIAN COMMUNITY
OFFICE OF MEMBERSHIP SERVICES
MEMBERSHIP APPLICATION PACKAGE
MEMBERSHIP WITHIN THE SALT RIVER PIMA-MARICOPA INDIAN COMMUNITY IS DIRECTED BY THE
SRPMIC CONSTITUTION UNDER SECTIONS 1 AND 2 AS APPROVED ON JULY 27, 2005 BY
SECRETARIAL ELECTION AND FINAL APPROVAL BY THE WESTERN REGIONAL OFFICE, BUREAU OF
INDIAN AFFAIRS ON AUGUST 15, 2005.
INCOMPLETE APPLICATION’S WILL NOT BE PROCESSED AND WILL BE RETURNED TO THE APPLICANT.
Contact Information: Phone: (480) 362-7600 / Fax: (480) 362-7714
Mailing Address: 10005 E. Osborn Road, Scottsdale, Arizona 85256
Physical Address: Two Waters, Building B – 3
rd
Floor
10079 E. Osborn Road, Scottsdale, Arizona 85256
STEP 0NE:
STEP TWO:
MEMBERSHIP ELIGIBILITY
Are you a biological lineal descendent of
an original Salt River Allottee?
NO
YOU ARE NOT ELIGIBLE FOR MEMBERSHIP
ENROLLMENT WITH THE SALT RIVER PIMA-
MARICOPA INDIAN COMMUNITY
1) Are you at least 1/4 th degree Indian
blood?
AND
2) Are you the biological child or biological
grandchild of an enrolled member of the
SRPMIC?
AND
3) Are you a United States Citizen?
4) Are you enrolled in any other federally
recognized tribe?
OR
5) Have you ever relinquished enrollment
from any other federally recognized tribe?
1) Are you a biological lineal descendent of
an original Salt River allottee?
AND
2) Are you at least 1/4th degree Indian
blood?
AND
2) Are you the biological child or biological
grandchild of an enrolled member of the
SRPMIC?
AND
3) Are you a United States Citizen?
If you were enrolled in another
federally recognized tribe, have you
relinquished your enrollment?
YOU MUST FIRST RELINQUISH YOUR ENROLLMENT AND
THEN YOU MAY PROCEED WITH FILLING OUT A PRE-
APPLICATION FORM AND MEMBERSHIP APPLICATION.
RELINQUISHMENT AND FILING OF A
MEMBERSHIP APPLICATION ALL MUST BE
DONE WITHIN 180 DAYS OF TURNING THE AGE
OF 18.
Please proceed and fill out the Pre-
Application Review form and
Membership Application.
NO
YOU ARE NOT ELIGIBLE FOR MEMBERSHIP
ENROLLMENT WITH THE SALT RIVER PIMA-
MARICOPA INDIAN COMMUNITY
YES
YES
NO
NO
Are you filing an application for
membership with the SRPMIC within 180
days after turning the age of 18?
Please proceed and fill out the Pre-
Application Review form and Membership
Application.
YES
YOU ARE NOT ELIGIBLE FOR MEMBERSHIP
ENROLLMENT WITH THE SALT RIVER PIMA-
MARICOPA INDIAN COMMUNITY
YES
YES
PLEASE PROCEED TO STEP
TWO.
SRPMIC – Membership Application Package
Salt River
PIMA-MARICOPA INDIAN COMMUNITY
10,005 E. Osborn Rd. / Scottsdale, Arizona 85256--9722 / Phone (480) 362-7400
Office of Membership Services
Phone: (480) 362-7600 Fax: (480) 362-7714
PRE-APPLICATION REVIEW FORM
PLEASE READ CAREFULLY TO UNDERSTAND THE ELIGIBILITY AND PROCESS OF APPLYING FOR
MEMBERSHIP WITH THE SALT RIVER PIMA-MARICOPA INDIAN COMMUNITY.
Constitution of the Salt River Pima-Maricopa Indian Community
Article II – MEMBERSHIP
Section 1. Membership By Right. The membership of the Salt River Pima-Maricopa Indian Community shall consist
of:
a) All person of Indian blood whose names appear, or rightfully should appear, on the official allotment
roll of the Salt River Pima-Maricopa Indian Community; and
b) All person whose names validly appear on the latest duly certified membership roll of the Salt River
Pima-Maricopa Indian Community; provided that the Community Council may correct such roll in
accordance with applicable Community law; and
c) Any biological lineal descendent of an original Salt River Allottee who meets all of the following:
(1) is at least one-fourth (1/4) degree of Indian blood; and
(2) is the biological child or the biological grandchild of an enrolled member of the Salt River
Pima-Maricopa Indian Community; and
(3) is a United States citizen; and
(4) is not enrolled in any other federally recognized tribe; and
(5) has never relinquished enrollment from any other federally recognized tribe; (with
exception to Article II, Section 2).
*Section 2. Membership of Minors Enrolled Elsewhere. Any person enrolled in any other federally recognized Tribe
before reaching the age of eighteen (18) years is eligible for enrollment by right with the Salt River Pima-Maricopa
Indian Community if such person:
a) (1) is a biological lineal descendent of an original Salt River allottee; and
(2) is at least one-fourth (1/4) degree of Indian blood; and
(3) is the biological child or the biological grandchild of an enrolled member of Salt River Pima-
Maricopa Indian Community; and
(4) is a United States citizen; and
b) Files an application for enrollment with the Community within one hundred and eighty (180) days
after turning eighteen (18) years of age; and
c) Relinquishes membership in any other federally recognized tribe before filing an application for
enrollment with the Community.
Application:
- A person seeking to
begin the membership
enrollment process
must submit an
application for
membership to the
SRPMIC Membership
Office.
Pre-Application
Review:
- The SRPMIC Membership
Office will provide each
applicant with a document
checklist to complete a
membership application
and an initial evaluation
regarding the sufficiency
of the applicant's
documentation.
Confirmation of
Application:
- The SRPMIC shall issue a
written letter confirming
receipt of the submitted
application and supporting
documentation within 5
business days of receipt of
the application.
- A confirmation letter does
not imply or convey any
rights or benefits of the
applicant in regards to
membership within the
SRPMIC.
Review of Application &
Supporting Documentation:
- Within 60 calendar days of the
receipt of a complete enrollment
application, the Membership
Office will review the application
and supporting documentation
to determine whether the
applicant meets the Membership
criteria.
SRPMIC – Membership Application Package
Salt River
PIMA-MARICOPA INDIAN COMMUNITY
Community Development Department
Membership and Real Property Management
10005 E. OSBORN RD. SCOTTSDALE, ARIZONA 85256-9722
PHONE (480) 362-7600, FAX (480) 362-7714
PRE-APPLICATION REVIEW CHECKLIST
Date:
Applicant Name:
Date of Birth:
Minor
*18 Year Old (applying within 180
days)
Adult (never enrolled at SRPMIC or
any other Tribe)
Parent / Guardian Name: (for minor/protected person)
Applicant
(INITIAL)
(please initial the documents submitted with the application)
MRPM
Staff
Membership Application (signed and notarized)
Copy of Original Certified Birth Certificate
Copy of Amended Certified Birth Certificate (for adoption or paternity)
Copy of Certified Birth Certificate/Death Certificate for Parent of Applicant (for eligibility
through Grandparent)
Social Security Card
Minor/Protected Information-Verification form
Adult Per Capita Certification form
Certification of Degree of Indian Blood (CDIB) for parent(s)
Verification of Non-Enrollment/Relinquishment/Burden of Proof (list tribes):
Tribal Paternity Order (required if father is not listed on the birth certificate)
Court Order (custody / guardianship divorce decree, name change and / or adoption)
NOTES
BY SIGNING THIS PRE-APPLICATION REVIEW, I AM CONFIRMING THAT I HAVE TAKEN THE STEPS
NECESSARY TO SUBMIT A COMPLETE APPLICATION AND THAT I UNDERSTAND THE SRP-MIC
MEMBERSHIP ELIGIBILITY REQUIREMENTS AND APPLICATION PROCESS.
Applicant/Guardian’s Signature
Date
Membership Office Staff
Date
SRPMIC – Membership Application Package
Salt River
PIMA-MARICOPA INDIAN COMMUNITY
10,005 E. Osborn Rd. / Scottsdale, Arizona 85256--9722 / Phone (480) 362-7400
Office of Membership Services
Phone: (480) 362-7600 Fax: (480) 362-7714
APPLICATION FOR MEMBERSHIP
INCOMPLETE APPLICATION’S WILL NOT BE PROCESSED AND WILL BE RETURNED TO THE APPLICANT.
Date:
Applicant’s Information
Applicant:
Minor
*18 Year Old (applying
within 180 days)
Adult (never enrolled at
SRPMIC or any other Tribe)
Adopted Child/Adult
Applicant Name:
Date of Birth: Place of Birth:
Social Security Number:
Sex:
Male
Female
Address:
City:
State:
Zip Code:
Phone Number
Other Phone Number:
E-mail Address:
Membership Eligibility through Biological:
Parent(s) / Guardian(s) Name(s):
*Relinquishing Membership from:
Parent(s)
Grandparent(s)
Total degree of Indian Blood: Pima Maricopa Other:
Is the applicant eligible for membership with other Tribes?
No
Yes
If Yes, please name the Other Tribe(s):
Applicant’s Parental Information
Biological Father’s Name:
Biological Mother’s Name (Include Maiden):
Tribal Affiliation:
Tribal Affiliation:
Date of Birth:
Date of Birth:
Enrollment #:
Blood Degree:
Enrollment #:
Blood Degree:
Other Tribal Affiliations:
Other Tribal Affiliations:
Biological
(Father’s Father)
Grandfather:
Biological
(Mother’s Father)
Grandfather:
Tribal Affiliation:
Tribal Affiliation:
Date of Birth:
Date of Birth:
Enrollment #:
Blood Degree:
Enrollment #:
Blood Degree:
Other Tribal Affiliations:
Other Tribal Affiliations:
Biological (Father’s Mother) Grandmother:
Biological (Mother’s Mother) Grandmother:
Tribal Affiliation:
Tribal Affiliation:
Date of Birth:
Date of Birth:
Enrollment #:
Blood Degree:
Enrollment #:
Blood Degree:
Other Tribal Affiliations:
Other Tribal Affiliations:
SRPMIC – Membership Application Package
APPLICANT’S AFFIDAVIT:
Initial(s)
required:
The undersigned hereby certifies that the information above is true and correct to the
best of his / her knowledge.
AND
I, affirm with this affidavit that the documents submitted verify that the applicant has
never been enrolled in another federally recognized tribe, and has never relinquished
membership in any other federally recognized tribe;
OR
I, affirm with this affidavit that applicant is applying for membership within 180 days of
turning eighteen (18) years of age, and applicant attests that he / she has relinquished his
/ her membership before filing this application.
Relinquished Membership from:
On (date):
Approval date:
Resolution No.:
AND
I, UNDERSTAND AND ACKNOWLEDGE THAT IF MY APPLICATION FOR MEMBERSHIP WITH THE
SRPMIC CONTAINS FALSE INFORMATION OR I HAVE WRONGLY WITHHELD ANY RELEVANT
INFORMATION OR UNDER ANY FRAUDULENT ACTS HAVE BEEN MISREPRESENTED THAT I
MAY BE PROSECUTED AND LIABLE FOR A CIVIL FINE UP
TO FIVE THOUSAND ($5,000.00)
DOLLARS, PURSUANT TO SRO-354-2010, SECTION 2-3.1.
STOP! DO NOT SIGN – MUST BE SIGNED IN FRONT OF A NOTARY.
Print Name of person filing this application
Signature of Person filing this
application
Relationship to applicant:
Date:
State of:
County of:
Subscribed and sworn (or affirmed) before me this
day of
, 20
by
Notary Public
SRPMIC – Membership Application Package
Salt River
PIMA-MARICOPA INDIAN COMMUNITY
Community Development Department
Membership and Real Property Management
10005 E. OSBORN RD. SCOTTSDALE, ARIZONA 85256-9722
PHONE (480) 362-7600, FAX (480) 362-7714
VERIFICATION ON NON-ENROLLMENT
TO BE COMPLETED BY APPLICANT:
APPLICANT: If you have blood degrees or are eligible for enrollment with any other Tribe(s),
you must send a copy of this form with SECTION A completed to those tribal enrollment
office(s), so that they can complete SECTION B. Their office will return it to this office.
TO BE COMPLETED BY OTHER TRIBAL ENROLLMENT OFFICE:
TO THE “OTHER TRIBAL” ENROLLMENT OFFICE: The above individual is applying for
membership with the Salt River Pima-Maricopa Indian Community and is therefore
responsible for securing the “Burden of Proof” that he / she is not enrolled, has never
relinquished enrollment from another federally recognized tribe and does not have a pending
application for enrollment with your Tribe. Please return to our office at the address or fax
listed above.
Salt River
PLEASE CHECK YOUR TRIBAL RECORDS AND ANSWER THE FOLLOWING QUESTIONS
Is the applicant enrolled as a member?
Yes
No
If Yes. When?
Roll No.
Was the applicant an enrolled member and relinquished their enrollment?
Yes
No
If, Yes. When?
Resolution No.:
(Please provide copy of Resolution)
Has the applicant applied and/or has an application pending for enrollment with your Tribe?
Yes
No
If, Yes. When?
(Please provide official documentation of non-enrollment and/or relinquishment)
Is the applicant’s father enrolled as a member?
Yes
No
If Yes, a Certificate of Degree of Indian Blood is requested.
Is the applicant’s mother enrolled as a member?
Yes
No
If Yes, a Certificate of Degree of Indian Blood is requested.
Certified on behalf of the:
Tribe.
Signature
Title
Date
(Please complete this information to the best of your knowledge)
Applicant Name:
D.O.B.:
Applicant’s Father’s Name:
D.O.B.:
Tribe:
Roll No.:
Blood Quantum:
Applicant’s Mother’s Name:
D.O.B.:
Tribe:
Roll No.:
Blood Quantum:
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Completed 20 July 2020

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