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Dear Applicant Yellowhawk Tribal Health Center Yellowhawk Form
RESERVATION PLEASE GIVE NAME AND STATE PREVIOUS ADDRESS-STREET TRIBAL BLOOD QUANTUM RESIDING ON TRUST LAND YES OR NO YES BIRTHPLACE DATE LEFT NO ENROLLED ROLL IF KNOWN TOTAL BLOOD QUANTUM LIST MAIDEN NAME OR OTHER NAMES YOU HAVE USED FATHER S NAME GIVE NAME OF HEAD OF HOUSEHOLD MOTHER S MAIDEN NAME IF FULL TIME STUDENT GIVE SCHOOL NAME AND CITY OTHER MEMBERS OF YOUR HOUSEHOLD SEX M or F RELATIONSHIP DATE CLASSES BEGAN BLOOD QUANTUM ENROLLED NUMBER IHS USE 46a 46b 46c 46d 46e 46f 46g 46h 47a 47b...
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