Tribal Member Non-Tribal Member
Name: Phone Number:
Mailing Address:
Email Address:
Tribal Rental Emergency Elder Disabled
Substandard
Plumbing Electrical Septic Structural Leak Other:
Signature:
Date:
(Please make sure to check below all that apply.)
Tribal Rental Maintenance Request
Please describe in detail of repairs and or replacements that are needed.
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signature
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