Wednesday, September 22, 2015

RE: CHRISTMAS DISBURSEMENT APPLICATION

Dear Band Members,
On behalf of our Chief and Council, I am pleased to announce we will be providing Christmas assistance of
$100 per Sipeknekatik band member. Those Sipeknekatik band members who have custody and/or
control of other Sipeknekatik band members 17 years old and younger will receive an additional $100
dollars per minor. (For example: a single parent family with three children who are registered
Sipeknekatik band members will receive a total payment of $400)
Enclosed with this letter is the application that must be completed and submitted to the Band no later than
January 31, 2016 at 12:00 noon. The Band will not accept any late applications under any circumstances.
Submission Criteria
All applications must be signed and dated. The Band reserves the right to request documentation such as,
and not limited to, a court order or proof of marriage, or proof of child custody. For families that have both
the mother and father living at the same residence the Christmas Disbursement payment will be issued in
the mother/wifes name.
You can send your application by using the following methods:
1. Mail to:
Attention: Deborah Maloney
Sipeknekatik
522 Church Street
Indian Brook First Nation, Nova Scotia
B0N 1W0
2. Hand delivery to the Band Office marked as Attention: Deborah Maloney
3. Fax to: 902-758-2017
4. Scan/Fax to email to Deborah Maloney (dmaloney@sipeknekatik.ca)
Disbursements
Christmas Disbursement payments will be released at the band office from December 14 to December 18,
2015, and again on January 4 to January 29, 2016. Band members will be responsible for making suitable
arrangements to collect their payment. If you wish to have your payment mailed, please check the box
provided on the application page. Otherwise, band members will be expected to pick up their payment in
person at the Band Office or make suitable arrangements. It will be at Bands discretion to release any and
all payments. Finally, please be advised that payments not picked up by February 29, 2016 will be
cancelled.
Should you need assistance with your application, Deborah Maloney will be available throughout this
process by using the information provided below.
Attn: Deborah Maloney
Ph: 902 758 2049
Cell:902 805 0214
Email: dmaloney@sipeknekatik.ca

In the Spirit of Christmas

Chief Rufus Copage

Sipeknekatik

****Christmas Disbursement Application 2015****

1. Last Name:

______________________________________________________

2. First Name:

______________________________________________________

3. Phone Number:

______________________________________________________

4. Address:

______________________________________________________
______________________________________________________
______________________________________________________
4 (a): Mail Payment
Yes

No

4 (b): Do you wish for your address to be included in our mail out list for the purposes of Band
elections, referendums, and other Sipeknekatik notices.
Yes
No

5. Band Number:
(ex: 0250000001)

6. Date of Birth:
(DD/MM/YYYY)

_______________________________________________________

7. Include number of dependents, spouse and band members 17 years old and younger
Last Name
First Name
Age
Band Number
DOB
(DD/MM/YYY)

This Section for Internal Office Use

Only

Total Payment
________________

Approval Signature
_______________________

APPLICATIONS MUST BE SUBMITTED TO THE BAND BY January 31, 2016 by 12 p.m. THE
BAND WILL NOT ACCEPT ANY LATE APPLICATIONS. All information provided on this form
will remain private and confidential.

Applicant Signature: _________________________

Date: ______________________