Please update my address as follows:

NAME:

First                               Middle                        Maiden                         Last

Other Names Known As:

Date of Birth:                                          Social Security Number:                          

Please forward address Bois Forte News:  YES   NO

Please list children to be included in address change

First                  Middle                       Last                Date of Birth         Social Security #

Old Address:

Street Address

City,   State    Zip Code

Current Address:

Street Address

City,   State    Zip Code

Sign/Date

****MAIL TO ADDRESS BELOW

Bois Forte Tribal Government

Attention:  Enrollment

PO Box 16

Nett Lake, MN 55772