Burial Forms Download Forms Burial Form - Traditional Services Assistance Date* MM slash DD slash YYYY Name of Tribal Member* First Last Roll Number* Date of Death* MM slash DD slash YYYY Person Filling Out Application* First Last Email Relationship to the Deceased* Applicant Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Funeral Home Name* Funeral Home Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Attention Assistance Not to Exceed $500.00 for Traditional Services. Appeal Rights Request for a Fair Hearing for services being denied regarding this application must be made in writing to the Business Committee of the Tonkawa Tribe of Oklahoma within fifteen (15) days of notification for services being denied. *NOTE* In accordance with January 21, 1988, Oklahoma Tax Commission’s determination, the Tonkawa Tribe of Oklahoma is EXEMPT from sales and/or use tax. The Tribe’s Federal Employer Identification Number is 73-0948136, copiers are available upon request.CommentsThis field is for validation purposes and should be left unchanged. Burial Form - Burial Assistance Application Date* MM slash DD slash YYYY Name of Tribal Member* First Last Roll Number* Date of Death* MM slash DD slash YYYY Person Filling Out Application* First Last Email Relationship to the Deceased* Applicant Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Funeral Home Name* Funeral Home Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Attention Assistance Not to Exceed $4,500.00 to Funeral Home. Service Provider: A signed and dated itemized statement and certified death certificate must be attached to this application before payment will be made. Appeal Rights Request for a Fair Hearing for services being denied regarding this application must be made in writing to the Business Committee of the Tonkawa Tribe of Oklahoma within fifteen (15) days of notification for services being denied. *NOTE* In accordance with January 21, 1988, Oklahoma Tax Commission’s determination, the Tonkawa Tribe of Oklahoma is EXEMPT from sales and/or use tax. The Tribe’s Federal Employer Identification Number is 73-0948136, copiers are available upon request.Upload itemized statement and death certificate Drop files here or Select files Accepted file types: jpg, png, pdf, Max. file size: 256 MB. CommentsThis field is for validation purposes and should be left unchanged.
