Address Change Request - Santa Ynez Band of Chumash Indians

Requestor Information

Who is filling out this form

(Select all that apply)

Homeowner

Head of Household (Tribal Correspondence purposes)

Name(Required)

First Last

Birth Date(Required)

Requestor Email(Required)

Phone

Cell

Correspondence Preference

Email only

Hard copy mailings only

No mailings

If no box is checked and email address is provided default will be "Email Only"

Address Change Information

Effective Date of Address Change(Required)

Current Address(Required)

Street Address Address Line 2 City State ZIP Code

Mailing address is different from current address?(Required)

Yes

Mailing Address (only necessary if different from currrent address)(Required)

Street Address Address Line 2 City State ZIP Code

List of additional people who will be living at the new address (not including yourself)

Family members included in the address change:

Name	Relationship	Date of Birth	Actions

There are no Family members.

Santa Ynez Chumash Reservation Residency

IF you are moving on to the Santa Ynez Chumash Reservation, you must submit proof of residency by providing one of the items below:

Utility Bill - Tribal wastewater bill is not acceptable
Federal Income Tax Return - Copy of the upper half only
Residency Declaration - Residency declaration can only be selected by the homeowner, not the head of household. If you are the head of household, and are unable to provide a tax return or utility bill as proof of residency, please check your email for a confirmation message after submitting this form. It will have further instructions that you'll need to follow.

Type of proof of residency document(Required)

Utility Bill

Federal Income Tax Return

Residency Declaration

I don't have one

The Residency Declaration is only to be filled out by the homeowner. If you are the head of household, and are unable to provide a tax return or utility bill as proof of residency, please check your email for a confirmation message after submitting this form. It will have instructions on how to proceed. Be sure to check your spam folder if you aren't seeing the email.

Residency document upload

Max. file size: 250 MB.

Residency Declaration I hereby state that I am the owner of the residence located on the Santa Ynez Chumash Reservation at the current address noted above and I verify that the family member(s) listed on this form reside(s) at this address and further verify that this is his/her primary residence. Should additional documents proving residency be required, I confirm that I am willing to provide them upon request.

Requestor Signature(Required)

TO BE COMPLETED BY HOMEOWNER ONLY IF REQUESTOR IS MOVING ON TO THE SANTA YNEZ RESERVATION AND IS UNABLE TO PROVIDE PROOF OF RESIDENCY

I ____________________________ (Homeowner name - please print) hereby state that I am the owner of the residence located on the Santa Ynez Chumash Reservation at the current address noted above and I verify that the requestor on this form resides at this address and further verify that this is his/her primary residence.

Should additional documents proving residency be required, I confirm that I am willing to provide them upon request.

Homeowner Signature ____________________________________________

Date _______________________