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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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* Required
Company/Business Name (Who is the form going to?)
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Your answer
Full First, Middle, and Last Name
*
Your answer
Valid Phone Number
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Your answer
Mailing Address: P.O. Box / City / State / Zip code
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Your answer
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"
Your answer
Physical Address: Directions from San Juan Chapter to your home. Example: "My home is located 1 1/2 miles, E of San Juan Chapter."
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Your answer
Number of years at current residence?
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Your answer
Are you a registered voter at San Juan Chapter?
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Yes
No
Email
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Your answer
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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