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Residence Verification Form
Please complete with correct information, whole form must be fully completed.

SERVICES ARE FOR REGISTERED VOTERS ONLY

Please note: Residence Verifications are $2.00 a page, plus the Navajo Nation Tax.
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Company/Business Name (Who is the form going to?) *
Full First, Middle, and Last Name *
Valid Phone Number *
Mailing Address: P.O. Box / City / State / Zip code *
Physical Address: As stated on your current I.D./Driver's License. If you do not have one, use an address you prefer. Example: "18 M W on N36 MM 12"
Physical Address: Directions from San Juan Chapter to your home. Example: "My home is located 1 1/2 miles, E of San Juan Chapter." *
Number of years at current residence? *
Are you a registered voter at San Juan Chapter? *
Email *
Residence Verifications may be picked up at our Service Window.
OPEN: Monday - Friday, from 8:00 AM to 5:00 PM
CLOSED: On Holidays and Weekends
CLOSED DAILY: From 12:00 PM to 1:00PM for lunch.
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