Fillable Form 1: IN THE HO-CHUNK NATION TRIAL COURT (Ho-Chunk Nation)

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Form 1: IN THE HO-CHUNK NATION TRIAL COURT (Ho-Chunk Nation)

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The Form 1: IN THE HO-CHUNK NATION TRIAL COURT (Ho-Chunk Nation) form is 7 pages long and contains:

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Country of origin: US
File type: PDF

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IN THE
HO-CHUNK NATION TRIAL COURT
In the Interest of Ward(s)/
Minor Child or Adult CTF
Beneficiary:
___________________________________
Name
Date of Birth
Tribal ID No. 439A00 __ __ __ __
[Four Numbers]
v.
Ho-Chunk Nation
Office of Tribal Enrollment
P
ETITION FOR RELEASE OF PER
C
APITA DISTRIBUTION
Case No.:
CF / IF _____ - _____
[Assigned by the Court]
I, , come before the Ho-Chunk Nation
Trial Court on behalf of: (choose one)
myself, an Adult CTF Beneficiary and Ho-Chunk Tribal Member;
1
OR
the above-named minor child/ward as a: (please specify)
parent of the minor child listed above, OR
a court-appointed legal guardian of the child/ward listed above, and I have
attached the required legal documentation to support this statement.
1
The CTF monies of an adult beneficiary “shall be held on the same terms and conditions applied during the member-
beneficiary’s minority.” H
O-CHUNK NATION PER CAPITA ORDINANCE, 2 HCC § 12.86(1). References herein to
“ward/minor child(ren)” shall encompass requests by adult CTF beneficiaries aged eighteen (18) to twenty-five years.
P:\Pet. for Release of Per Cap. Distrib. (2018) Page 1 of 7
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My current address is:
Address [State physical address after P.O. Box if needed]
City State Zip Code
My telephone number is: ( ) |( )
Home Work [if available]
My fax number is (if any): ( )
My email address (if any):
My social security number:
My Ho-Chunk Nation tribal enrollment number (if any) is:
Tribal ID No. 439A00 __ __ __ __
[Four Numbers]
The minor child/ward presently reside(s) at: (if different from above)
Physical address
City State Zip Code
Non-petitioner parent(s)
__ reside(s) at:
Physical address
City State Zip Code
The Ho-Chunk Nation tribal enrollment number (if any) of the non-petitioner parent(s) is:
Tribal ID No. 439A00 __ __ __ __
[Four Numbers]
P:\Pet. for Release of Per Cap. Distrib. (2018) Page 2 of 7
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APPLICABLE LAW
The applicable law governing the petition for release of per capita funds is the HO-CHUNK
NATION PER CAPITA DISTRIBUTION ORDINANCE, 2 HCC § 12 (2003). Pursuant to Paragraph 8c of the
HO-CHUNK NATION PER CAPITA DISTRIBUTION ORDINANCE, monies held in the Trust Fund of a
minor or legally incompetent member may be available for the benefit of a beneficiary’s health,
education and welfare when the needs of such person are not met through other Tribal funds or other
state or federal public entitlement programs, and upon a finding of special need by the Ho-Chunk
Nation Trial Court. By the authority of the HO-CHUNK NATION PER CAPITA DISTRIBUTION
ORDINANCE, Paragraph 8c, I provide this written request to the Court for the release and
disbursement of funds on behalf of the minor child/ward listed in this petition. I understand that
access to my minor child/ward trust fund is restricted and swear that this is a last resort in
providing for the care and needs of my minor child/ward.
JURISDICTION & PETITIONER RESPONSIBILITY
I, as the parent or legal guardian of the minor child/ward listed above, do hereby, on behalf
of the minor child/ward, recognize and consent to the jurisdiction of the Court. I request that
the Court enter an Order for the release of per capita funds based on this petition satisfying
the requirements of the HO-CHUNK NATION PER CAPITA DISTRIBUTION ORDINANCE, Paragraph 8c.
I pledge that the funds, if released, will be used for the benefit of the minor or legally incompetent
tribal member. I understand that as the parent or legal guardian, I shall maintain and produce
records sufficient to demonstrate that the funds disbursed were expended as required by the
HO-CHUNK NATION PER CAPITA DISTRIBUTION ORDINANCE and any applicable federal law.
P:\Pet. for Release of Per Cap. Distrib. (2018) Page 3 of 7
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Below is a set of questions which require a short, plain and explanatory answer in order
to determine the merits of your request. Failure to answer each question may result in the
return or dismissal of this Petition. The petitioner must also include documentation
supporting each answer. Examples of supplemental documentation may include proof of medical
insurance, bank accounting statements or invoices, a copy of a court order awarding custody to the
petitioner, class schedules, school enrollment, proof and/or verification of disability or chronic
medical condition by a physician, estimated household budgets, public assistance checks or
vouchers, or denial of services by federal, state or tribal programs, etc.
Nature of Request:
Provide the name and contact information of the proposed vendor and a brief statement
explaining the requested use of monies released from the Children’s/Incompetent’s Trust Fund
account(s). If seeking funds payable to more than one vendor, please attach additional pages
containing the following information for each request.
Amount Requested: $_________________________
Vendor Information: ____________________________________________________________
Name
____________________________________________________________
Address [State physical address after P.O. Box if needed]
____________________________________________________________
City State Zip Code
( ) ( )
Phone Fax (if applicable)
Goods Purchased/Services Performed:
P:\Pet. for Release of Per Cap. Distrib. (2018) Page 4 of 7
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Education, Health & Welfare:
The request shall benefit the health, education and/or welfare of the minor child/ward in the
following manner, e.g., the minor child/ward is/are physically or learning disabled, the minor child/
ward attends school that is insufficient to meet educational goals, the minor child/ward have/
has special needs requiring care above and beyond that of a typical child (attach additional pages,
if necessary):
Necessity vs. Want or Desire:
The minor child/ward need(s) these funds for the following reasons (attach additional pages,
if necessary):
P:\Pet. for Release of Per Cap. Distrib. (2018) Page 5 of 7
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Financial Hardship:
I am financially unable to provide, in whole or in part, for the identified needs of the minor
child/ward based upon the following, e.g., unemployment, limited household income,
absence of child support or financial contribution of any type from the non-custodial parent(s)
(attach additional pages, if necessary):
Exhaustion of all other methods of funding:
Available tribal, state and federal resources and/or entitlements are not sufficient to meet the
current needs of the minor child/ward based upon the following, e.g., denial of education
assistance by the HCN Education Department, expulsion from the local public school system, denial
of assistance from any HCN program such TERO or Labor, denial of assistance from the HCN
Legislature, denial of services from local, county social services programs such as medical care or
child care (attach additional pages, if necessary):
P:\Pet. for Release of Per Cap. Distrib. (2018) Page 6 of 7
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For the reasons stated above, and with the supporting documentation attached, the petitioner
requests that the Court enter an Order directing the Nation to release funds to the recognized parent
or legal guardian of the above named minor child/ward.
NUMBER OF ADDITIONAL PAGES USED: ________
RESPECTFULLY SUBMITTED this _______ day of _________________, 20______.
Month Year
Signature:
Signature of Counsel (if any):
Address of Counsel:
Street address or P.O. Box
City State Zip code
Phone Number of Counsel: ( )
Fax Number of Counsel:
( )
Ho-Chunk Bar Number of Counsel:
If not a member of the Ho-Chunk bar, a Motion to Appear Pro Hac Vice has been
attached in accordance with Ho-Chunk Nation Rules of Civil Procedure, Rule 16(B),
2
and/or I
have applied for membership in the Ho-Chunk bar in accordance with the Ho-Chunk Nation Rules
for Admission to Practice.
2
Parties can obtain a copy of the Ho-Chunk Nation Rules of Civil Procedure by contacting the Ho-Chunk Nation
Judiciary at (715) 284-2722 or (800) 434-4070 or visiting the judicial website at
www.ho-
chunknation.com/?PageID=123.
P:\Pet. for Release of Per Cap. Distrib. (2018) Page 7 of 7
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Form 1: IN THE HO-CHUNK NATION TRIAL COURT (Ho-Chunk Nation)

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Completed 23 December 2020

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