YAKAMA NATION CREDIT ENTERPRISE
Post Office Box 1160, Toppenish, WA 98948
Area Code 509: 865-7156 * 865-7157
FAX 865-4288
PER CAPITA-BASED FUNERAL LOAN
~ Official Death Notice Required ~
APPLICANTS PERSONAL INFORMATION
First Name Initial Last Name
Mailing Address City State Zip
Please list the names of your parents (living or deceased):
Mother (maiden name): Father:
Which parent is related to deceased and how:
Please List your grandparents (living or deceased):
INFORMATION REGARDING DECEASED
Describe Family Tree Relationship (How Are You Directly Related?). MY:
SPOUSE - PARENT - SON - DAUGHTER - BROTHER - SISTER - GRANDPARENT - GRANDCHILD - UNCLE
AUNT - NEPHEW - NIECE - COUSIN - IN-LAWS AND/OR STEP RELATIVES IN ONE OF THE ABOVE CAPACITIES
NOTICE TO FUNERAL LOAN APPLICANTS: COMMITTEE ACTION NUMBER: #074-99
o If the applicant is a family member of the deceased but does not have any apparent means of repayment, the
maximum that can be loaned by the Credit Officers for funeral expenses based on per capita hold is $200 per
funeral, not to exceed $600 total in a Fiscal Year.
o If the client is in delinquent status, the initial funeral loan will be authorized contingent upon the loan client’s
agreement to work with the Credit Officer and/or the Collections department to make satisfactory payment
arrangements for the delinquent loan(s). The per capita payment will be first applied to the funeral loan.
o The loan client will not be eligible for future funeral loans if the arrangements are not made.
o Tribal members with adequate repayment capability can make loans larger than $200 through the standard credit
lending process. If the ceiling of the $600 in a fiscal year is reached, standard credit lending practices apply.
PLEASE READ BEFORE SIGNING;
In Accordance with the Declaration of Policies and Plan of Operation Title 20-Section D; “If the applicant falsifies his/her application or conceals
his/her liabilities, loan(s) will not be approved.”
The undersigned specifically acknowledges and agrees that verification of any information contained in the application may be made at any time by
the Lender, its agents, successors and assigns, either directly or through a credit reporting agency, from any source named in this application, and
the original copy of this application will be retained by the Lender, even if the loan is not approved.
Certification: I certify that the information provided in this application is true and correct as of the date set forth opposite my signature on
this application, and I have read and understand the requirements for per capita based funeral loans as described above in the NOTICE
TO FUNERAL LOAN APPLICANTS.
I also state that there are no other holds on my per capita that obligate funds for the repayment of this loan.
X____________________________________________________________
_________ DATE__________________________________________
~SIGN AND DATE WITH BLACK OR BLUE INK~
