Fillable UNIVERSAL CITIZENSHIP FORM MAIL OUT (Muscogee)

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UNIVERSAL CITIZENSHIP FORM MAIL OUT (Muscogee)

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The Muscogee (Creek) Nation of Oklahoma
Citizenship Board
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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
Director
Nathan Wilson
Managers
Andy Proctor
Allan Colbert Jr.
Board Members
Joan Henson
Elizabeth Yahola
Clarence Johnson
Leonard Gouge
Lea Ann Nix
The Muscogee (Creek) Nation of Oklahoma
Citizenship Board
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: 04/04/2019
Director
Nathan Wilson
Managers
Andy Proctor
Allan Colbert Jr.
Board Members
Joan Henson
Elizabeth Yahola
Clarence Johnson
Leonard Gouge
Lea Ann Nix
Stand-Alone
Primary Form of Identification
Primary Form of Identification
(with a Secondary form of ID)
Secondary Form of Identification
•
State ID Card or Driver’s License
(No more than 3 months expired)
•
Oklahoma Self Defense Act
License (Concealed/Open Carry
License) (No more than 3 months
expired)
•
United States Passport (No more
than 3 months expired)
•
Out-of-State Drivers License
•
**Current Citizenship ID Card
with Photo (No more than 3
months expired)
•
An identification document
issued by the United States
Armed Services (Issued by the
Department of Defense); one of
the following:
•
Military identification card
•
Military dependent
identification card
•
Birth Certificate
•
FS-240 form: Consular Report of
Birth Abroad
•
Any primary proof of
identification, which is not used as
the primary ID for a U.S. citizen
•
For any person under the age of
18, an affidavit signed by the
parent or legal guardian
•
Identification Document issued
by one of the following:
•
Oklahoma public, private, or
parochial secondary school
•
Oklahoma institution of higher
education
•
Oklahoma technology center
school
•
Oklahoma employer
•
Oklahoma gun permit
•
Pilot license
•
Oklahoma lifetime hunting or
fishing license
•
Oklahoma voter identification
card
•
Social Security card
•
Health insurance card
•
Oklahoma Medical Marijuana
Adult/Minor Patient Card
•
Motor vehicle registration or title
•
Marriage certificate
•
Separation or divorce judgment
•
Professional degree, certificate, or
license
•
Deed or title to property in
Oklahoma, including a burial plot
deed
•
Health, life, or home insurance
policy issued to the applicant
•
Automobile insurance policy or
security verification form issued to
the applicant
•
A valid U.S.D.O.T. health card, as
required by 49 C.F.R. Part 391
•
**Digital photograph comparison,
if a digital photograph is already
on file with the MCN Citizenship
Office
•
Military discharge (DD-214),
unless specified not to be used for
identification
The Muscogee (Creek) Nation of Oklahoma
Citizenship Board
UNIVERSAL CITIZENSHIP FORM
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: 01/31/2020
Director
Nathan Wilson
Managers
Andy Proctor
Allan Colbert Jr.
Board Members
Joan Henson
Elizabeth Yahola
Clarence Johnson
Leonard Gouge
Lea Ann Nix
(REQUIRED) Signature:
(If applicant’s under the age of 18, need a Parent or Legal Guardian’s Signature)
(ETC for Minor, Requires signatures from both Parents/Guardians)
Date:
(REQUIRED) Print Name:
(If applicant’s under the age of 18, need a Parent or Legal Guardian’s Printed Name)
(ETC for Minor, Requires both Parents/Guardians’ Printed Names)
Do you want your Social Security Number visible on your New Citizenship Card? (Not for ETC)
(Eligible, If the Citizen is 18 years of age or older and Social Security card is on file)
YES
NO
Same As
Physical
Address
Mailing Address:
City:
State:
Zip Code:
County:
Address
Change
Physical Address (NO PO BOX):
City:
State:
Zip Code:
County:
Name (First, Middle, Last (Maiden):
Date of Birth:
Social Security Number:
Phone Number(Home/Cell):
Email(Optional):
[For All Citizens-PASSPORT PHOTO] (DISREGARD FOR ETC)
Please enclose a PASSPORT PHOTO of yourself as well as a copy of your State Driver’s License
or State ID or If under 18 years old enclose the State Driver’s License or State ID of the parent/
legal guardian. Legal guardian must have certified court records regarding guardianship.
See attached True Copy Form for ID criteria and procedure
(Photo Criteria: color, 2”x2”, white background)
(NO Polaroid or Professional Photos)
(PHOTO REQUIRED WHEN THE NEW CITIZENSHIP CARD IS FIRST ISSUED OR “CARD EXPIRED” DATE HAS EXPIRED)
[For All Citizens-SIGNATURE] (DISREGARD FOR ETC)
Citizen’s signature is required in the box below if passport photo is submitted.
Children that can sign on their own must do so. Children who can't sign on their
own must have parent/legal guardian sign the parent/ legal guardian's name
followed by a hyphen "-" and their relationship to the child.
REPLACEMENT
(NO FEE)
REPLACEMENT
($5.00 FEE)
(CASH OR MONEY ORDER ONLY)
NAME CHANGE
(Please specify FEE or NO FEE)
ENHANCED
TRIBAL CARD
( ETC )
Jenks
Location
Only
Submit previous Citizenship Card
Senior Citizen (55 years or older)
Full Blood Creek Citizen
Veteran (Verifiable Document [DD Form 214])
Lost previous Citizenship Card
Marriage (Marriage License-No photocopy)
Divorce (Divorce Decree-No photocopy)
Legal Name Change (Contact Citizenship Office)
Adoption (Contact Citizenship Office)
NEW
ETC
Fee: $45
REPLACEMENT
ETC
Fee: $25
Reintegration (Fee Waived Document)
Stolen (Police Report)
Lost in House Fire (Fire Marshall Report)
Other Reason:
_____________________________
I declare under penalty of perjury that all information made in this document are true and correct.
The Muscogee (Creek) Nation of Oklahoma
Citizenship Board
REPLACEMENT ETC WORKSHEET
CAN I APPLY FOR AN ETC REPLACEMENT CARD?
Complete the checklist to determine your eligibility to apply for a Replacement ETC. Please circle YES or NO
I can submit my most recent Enhanced Tribal Card (ETC) with this application.
YES
NO
I was at least 16 years old when my most recent ETC was issued.
YES
NO
My ETC expires within six (6) months or is no more than one (1) year past the
expiration date.
YES
NO
The ETC card that I am renewing has not been mutilated, damaged, lost, stolen or
subsequently found.
YES
NO
My ETC has not been limited from the normal five (5) year validity period due to ETC
damage/mutilation or multiple ETC thefts/losses.
YES
NO
I use the same name as on my most recent ETC
—OR—
I have had my name changed by marriage or court order and can submit proper
certified documentation to reflect my name change.
YES
NO
If you answered NO to any of the statements above,
STOP - You are not eligible to receive a replacement ETC!
You must apply for a new ETC Card - Please check NEW ETC on Universal Citizenship Form.
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: 09/11/2018
Director
Nathan Wilson
Managers
Andy Proctor
Allan Colbert Jr.
Board Members
Joan Henson
Elizabeth Yahola
Clarence Johnson
Leonard Gouge
Lea Ann Nix
The Muscogee (Creek) Nation of Oklahoma
Citizenship Board
True Copy of Original Form of Identification(s)
I, _____________________________________________, (the adult applicant or parent/legal guardian of the applicant)
(Print First Middle Last Name)
affirm that the identification checked above and attached is/are a true and complete copy of the document which it purports
to represent.
Signature: __________________________________________ Date: __________________
You must sign and date this form in front of a Notary Public.
____________________________________________________________________________________________________________
NOTARY PUBLIC USE ONLY
State of _______________________
County of _____________________
Subscribed and sworn to before me this __________ day of _________________________________, 20_____.
____________________________________________
Notary Public Signature
My Commission Expires:______________________
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: 05/01/2019
Director
Nathan Wilson
Managers
Andy Proctor
Allan Colbert Jr.
Board Members
Joan Henson
Elizabeth Yahola
Clarence Johnson
Leonard Gouge
Lea Ann Nix
Please check the box(es) that apply and attach the designated color-copy ID to this Document
NOTARY STAMP
STAND-ALONE PRIMARY FORM OF
IDENTIFICATION
State ID Card or Driver’s License (No
more than 3 months expired)
Oklahoma Self Defense Act License
(Concealed/Open Carry License) (No More
than 3 months expired)
United States Passport (No more than 3
months expired)
Out-of-State Drivers License
**Current Citizenship ID Card with Photo
(No more than 3 months expired)
An identification document issued by the
United States Armed Services (Issued by
the Department of Defense); one of the
following:
Military identification card
Military dependent identification card
** Identity must have been verified with
acceptable identification and/or documentation
with the MCN Citizenship Office
SECONDARY FORM OF IDENTIFICATION
(Original Birth Certificate Required)
Any primary of identification, which is
not used as the primary ID for a U.S.
Citizen
For any person under the age of 18, an
affidavit signed by the parent or legal
guardian
Identification Document issued by the
one of the following:
Oklahoma public, private, or
parochial secondary school
Oklahoma institution of higher
education
Oklahoma technology center
school
Oklahoma employer
Oklahoma gun permit
Pilot license
Oklahoma lifetime hunting or
fishing license
Oklahoma voter identification card
Social Security card
Health insurance card
Cont…
SECONDARY FORM OF IDENTIFICATION
(Original Birth Certificate Required)
Oklahoma Medical Marijuana Adult/
Minor Patient Card
Motor vehicle registration or title
Marriage Certificate
Separation or divorce judgment
Professional degree, certificate, or
license
Deed or title to property in Oklahoma,
including a burial plot deed
Health, life, or home insurance policy
issued to the applicant
Automobile insurance policy or
security verification form issued to the
applicant
A valid U.S.D.O.T. health card, as
required by 49 C.F.R. Part 391
** Digital photograph comparison, if a
digital photograph is already on file
with the MCN Citizenship Office
Military discharge (DD-214), unless
specified not to be used for
identification
** Identity must have been verified with acceptable
identification and/or documentation with the MCN
Citizenship Office
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UNIVERSAL CITIZENSHIP FORM MAIL OUT (Muscogee)

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Completed 20 July 2020

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