The Muscogee (Creek) Nation of Oklahoma
Citizenship Board
I, _________________________________, (Born on: __________________ and Place of Birth:
Print MOTHER’S Full Maiden Name MOTHER’S Date of Birth
_______________________________) of lawful age, being first duly sworn, deposes and
MOTHER'S Place of Birth (State Only)
says as follows:
I hereby acknowledge I am the biological mother of ___________________________________,
Print CHILD’S Full Name
born on ____________________. The birth occurred in the State of and
CHILD’S Date of Birth
NO ADOPTION has taken place. I understand if I submit any false information, all rights and
privileges of citizenship in the Muscogee (Creek) Nation will be irrevocably removed.
____________________ __________________________________
Date Biological Mothers Signature & Roll No.
You must sign and date this form in front of a notary public.
State of _____________________
County of _____________________
Subscribed and sworn to before me this _______ day of _____________________, 20 ______.
My commission expires:
___________________ _________________________________
Notary Public
Muscogee (Creek) Nation ~ Citizenship Office ~ P.O. Box 580 ~ Okmulgee, OK 74447
You may contact our office at 1-800-482-1979 or (918) 756-8700, ext. 7940/7941/7942/7943
Revised: 05/13/2019
Nathan Wilson
Andy Proctor
Allan Colbert Jr.
Board Members
Joan Henson
Elizabeth Yahola
Clarence Johnson
Leonard Gouge
Lea Ann Nix