Please read this ENTIRE page for important information

regarding the CDIB Application requirements

CERTIFICATE OF DEGREE OF INDIAN BLOOD
The application for Certificate of Degree of Indian Blood (CDIB) must be completed showing your DIRECT lineage to an
original enrollee of the Final Choctaw Dawes Rolls BY BLOOD. (Please use both married and maiden names for females.)
The DAWES COMMISSION ROLL BOOK, the FINAL ROLL of the Five Civilized Tribes, which we use for Certification of
Degree of Indian Blood, was compiled mainly during the years 1899-1906. Anyone who died before 1899 or was born after
March 4, 1906 DOES NOT HAVE A ROLL NUMBER.
DOCUMENTS REQUIRED TO PROCESS APPLICATION
1. An ORIGINAL state certified (full form) birth certificate is required on the applicant. NO COPIES WILL BE
ACCEPTED. You must provide a state certified birth and death (if applicable) certificate for each person in your lineage back
to and including the enrollee, if the enrollee died after 1952. The original birth certificates will be mailed back once your
paperwork is complete.
2. Delayed birth and death certificates require additional supporting documents. We will provide you with the appropriate forms
if we do not have the information on file.
3. If you are adopted, you must trace your Choctaw blood through your natural (biological) parent(s). We will need a STATE
CERTIFIED FULL COPY BIRTH CERTIFICATE (after adoption) AND A COPY OF THE ADOPTION DECREE. If
the ADOPTION DECREE does not show the natural parent(s), you will ALSO need to submit one of the following: (1) Your
birth certificate before adoption, showing natural (parent(s) names or (2) PETITION TO ADOPT, that specifically names
your natural (biological) parents(s). We may require additional documents that prove natural parentage.
4. DO NOT go on-line to obtain a state birth certificate.
5. Provide copy of Social Security card for each applicant.
All applications must be accompanied by the required state certified birth/death certificates.
The state issued birth/death certificate must show full parentage and must be signed by the state registrar.
All birth certificates must display the state file number.
WE DO NOT ACCEPT HOSPITAL, CITY, COUNTY
OR STATE SHORT FORM BIRTH CERTIFICATES.
Mail completed applications and required documents to:
Choctaw Nation of Oklahoma
CDIB Office
P.O. Box 1210
Durant, OK 74702
Questions? Call toll free (800) 522-6170 or (580) 924-8280

D
a
t
e
:

_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
P
O

B
o
x
,

S
t
r
e
e
t

o
r

R
u
r
a
l

R
o
u
t
e
,

T
o
w
n

a
n
d

Z
I
P

c
o
d
e
I
s

a
p
p
l
i
c
a
n
t

a
d
o
p
t
e
d
?


Y
e
s

_
_
_
_
_


N
o
_
_
_
_
_
I
f

a
n
s
w
e
r

i
s

y
e
s
,

l
i
s
t

N
a
t
u
r
a
l

P
a
r
e
n
t
s
.


S
e
e

i
n
s
t
r
u
c
t
i
o
n
s

i
n

c
a
s
e

o
f

a
d
o
p
t
i
o
n
s
.
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
A
p
p
l
i
c
a
n
t
s

N
a
m
e
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
D
a
t
e

o
f

B
i
r
t
h
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
P
l
a
c
e

o
f

B
i
r
t
h
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
S
o
c
i
a
l

S
e
c
u
r
i
t
y

N
u
m
b
e
r
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
T
e
l
e
p
h
o
n
e

N
u
m
b
e
r
X
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
S
i
g
n
a
t
u
r
e

o
f

a
p
p
l
i
c
a
n
t
,

o
r

p
a
r
e
n
t

o
r

g
u
a
r
d
i
a
n

o
f

m
i
n
o
r
.
C
D
I
B


(




)

Y
E
S


(




)

N
O
M
o
t
h
e
r
:

(
M
a
i
d
e
n

n
a
m
e
)
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
T
r
i
b
e
:
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
R
o
l
l

N
u
m
b
e
r
:

_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
D
a
t
e

o
f

B
i
r
t
h
:

_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
D
a
t
e

o
f

D
e
a
t
h
:

_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
C
D
I
B


(




)

Y
E
S


(




)

N
O
C
D
I
B


(




)

Y
E
S


(




)

N
O
C
D
I
B


(




)

Y
E
S


(




)

N
O
C
D
I
B


(




)

Y
E
S


(




)

N
O
C
D
I
B


(




)

Y
E
S


(




)

N
O
F
a
t
h
e
r
:
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
T
r
i
b
e
:
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
R
o
l
l

N
u
m
b
e
r
:

_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
D
a
t
e

o
f

B
i
r
t
h
:

_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
D
a
t
e

o
f

D
e
a
t
h
:

_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
P
a
t
e
r
n
a
l

G
r
a
n
d
m
o
t
h
e
r
:
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
T
r
i
b
e
:
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
R
o
l
l

N
u
m
b
e
r
:

_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
D
a
t
e

o
f

B
i
r
t
h
:

_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
D
a
t
e

o
f

D
e
a
t
h
:

_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
M
a
t
e
r
n
a
l

G
r
a
n
d
f
a
t
h
e
r
:
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
T
r
i
b
e
:
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
R
o
l
l

N
u
m
b
e
r
:

_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
D
a
t
e

o
f

B
i
r
t
h
:

_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
D
a
t
e

o
f

D
e
a
t
h
:

_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
M
a
t
e
r
n
a
l

G
r
a
n
d
m
o
t
h
e
r
:
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
T
r
i
b
e
:
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
R
o
l
l

N
u
m
b
e
r
:

_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
D
a
t
e

o
f

B
i
r
t
h
:

_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
D
a
t
e

o
f

D
e
a
t
h
:

_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
P
a
t
e
r
n
a
l

G
r
a
n
d
f
a
t
h
e
r
:
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
T
r
i
b
e
:
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
R
o
l
l

N
u
m
b
e
r
:

_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
D
a
t
e

o
f

B
i
r
t
h
:

_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
D
a
t
e

o
f

D
e
a
t
h
:

_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
P
a
t
e
r
n
a
l

G
r
e
a
t
-
G
r
a
n
d
f
a
t
h
e
r
:
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
T
r
i
b
e

a
n
d

R
o
l
l

N
u
m
b
e
r
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
D
a
t
e

o
f

B
i
r
t
h
:

_
_
_
_
_
_
_

D
e
a
t
h
:

_
_
_
_
_
_
_
P
a
t
e
r
n
a
l

G
r
e
a
t
-
G
r
a
n
d
m
o
t
h
e
r
:
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
T
r
i
b
e

a
n
d

R
o
l
l

N
u
m
b
e
r
D
a
t
e

o
f

B
i
r
t
h
:

_
_
_
_
_
_
_

D
e
a
t
h
:

_
_
_
_
_
_
_
P
a
t
e
r
n
a
l

G
r
e
a
t
-
G
r
a
n
d
f
a
t
h
e
r
:
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
T
r
i
b
e

a
n
d

R
o
l
l

N
u
m
b
e
r
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
D
a
t
e

o
f

B
i
r
t
h
:

_
_
_
_
_
_
_

D
e
a
t
h
:

_
_
_
_
_
_
_
P
a
t
e
r
n
a
l

G
r
e
a
t
-
G
r
a
n
d
m
o
t
h
e
r
:
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
T
r
i
b
e

a
n
d

R
o
l
l

N
u
m
b
e
r
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
D
a
t
e

o
f

B
i
r
t
h
:

_
_
_
_
_
_
_

D
e
a
t
h
:

_
_
_
_
_
_
_
M
a
t
e
r
n
a
l

G
r
e
a
t
-
G
r
a
n
d
f
a
t
h
e
r
:
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
T
r
i
b
e

a
n
d

R
o
l
l

N
u
m
b
e
r
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
D
a
t
e

o
f

B
i
r
t
h
:

_
_
_
_
_
_
_

D
e
a
t
h
:

_
_
_
_
_
_
_
M
a
t
e
r
n
a
l

G
r
e
a
t
-
G
r
a
n
d
m
o
t
h
e
r
:
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
T
r
i
b
e

a
n
d

R
o
l
l

N
u
m
b
e
r
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
D
a
t
e

o
f

B
i
r
t
h
:

_
_
_
_
_
_
_

D
e
a
t
h
:

_
_
_
_
_
_
_
M
a
t
e
r
n
a
l

G
r
e
a
t
-
G
r
a
n
d
f
a
t
h
e
r
:
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
T
r
i
b
e

a
n
d

R
o
l
l

N
u
m
b
e
r
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
D
a
t
e

o
f

B
i
r
t
h
:

_
_
_
_
_
_
_

D
e
a
t
h
:

_
_
_
_
_
_
_
M
a
t
e
r
n
a
l

G
r
e
a
t
-
G
r
a
n
d
m
o
t
h
e
r
:
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
T
r
i
b
e

a
n
d

R
o
l
l

N
u
m
b
e
r
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
D
a
t
e

o
f

B
i
r
t
h
:

_
_
_
_
_
_
_

D
e
a
t
h
:

_
_
_
_
_
_
_
A
L
L

C
D
I
B

A
p
p
l
i
c
a
t
i
o
n
s

M
U
S
T

b
e

s
i
g
n
e
d
.
C
D
I
B

C
a
r
d
s

W
I
L
L

N
O
T

b
e

i
s
s
u
e
d

w
i
t
h
o
u
t

a

s
i
g
n
a
t
u
r
e
.
*
P
l
e
a
s
e

f
o
l
l
o
w

I
n
d
i
a
n

b
l
o
o
d
l
i
n
e
s

o
n
l
y
*
*
I
f

p
a
r
e
n
t

o
f

a
p
p
l
i
c
a
n
t

a
l
r
e
a
d
y

h
a
s

C
D
I
B

c
a
r
d
,

y
o
u

d
o

n
o
t

n
e
e
d

t
o

g
o

b
a
c
k

a
n
y

f
u
r
t
h
e
r
.
Application for:
Tribal Membership/Voters Registration
Choctaw Nation of Oklahoma
P.O. Box 1210, Durant, OK 74702
Phone: (580) 924-8280 or (800) 522-6170 Fax: (580) 924-4529
__________________________________________________________________________
Name (please print) First Middle Last Maiden (Cards always issued in maiden name)
__________________________________________________________________________
Physical Address Mailing address, if different City
__________________________________________________________________________
State ZIP Code County Phone Number
__________________________________________________________________________
Birthday Sex Social Security Number (Must be provided)
I CERTIFY THAT THE INFORMATION GIVEN IN THIS APPLICATION IS TRUE. I AM NOT A MEMBER OF ANOTHER TRIBE,
NOR AM I REGISTERED TO VOTE WITH ANOTHER TRIBE.
_________________________________ _________________________________
Signature Date
Please complete one for ALL minors. If under 16 years of age, a parent or guardian will need to sign. If 16 years of age
and older, then applicant will need to sign for themselves. Once a member reaches the age of 18 years then they can vote.
Residents: Residents of the Choctaw Nation 10 1/2 county service area will be registered to vote in the precinct in the county in which they
reside. Absentee voting will be allowed by written request to the Election Board Chairman prior to an election.
Non-Residents: Applicants residing outside the Choctaw Nation 10 1/2 county service area will be registered to vote by mail. If you live
outside of the Choctaw Nation boundaries, you may affiliate with ONE of the districts below, however, it is not required. Once you affiliate
you must remain in the district you have chosen, unless you move into the Choctaw Nation boundaries.
PLEASE CHECK THE PROPER DISTRICT AND PRECINCT.
District 1 District 4 District 7 District 10
0 Idabel 0 Poteau 0 Antlers 0 Atoka
0 Valliant 0 Spiro 0 Choctaw Council House 0 Kiowa
0 Summerfield 0 Rattan 0 Stringtown
District 2 0 Heavener 0 Wright City 0 Caddo
0 Broken Bow 0 Lane
0 Bethel District 5 District 8
0 Stigler 0 Hugo District 11
District 3 0 Kinta 0 Boswell 0 Hartshorne
0 Burkhart 0 Keota 0 Fort Towson 0 McAlester
0 Smithville 0 Spiro 0 Kiowa
0 Talihina District 9
0 Heavener District 6 0 Bennington District 12
0 Buffalo 0 Durant 0 Coalgate
0 Red Oak 0 Calera 0 Canadian
0 Wilburton 0 Atwood
0 Quinton 0 Tupelo
0 Arpelar