B08_SOL_Exhibit_A.docx

HOMESITE LEASE APPLICATION

NAME:

ADDRESS:

PHONE #:

TRIBAL ID#:

LAND TO BE BUILT ON:

Original Tribal Land

Land Acquisition

Allotted

(2.50 acres or less) (2.50 acres or less)

LEGAL DESCRIPTION OF REQUESTED LEASE (2.50 ACRES, M/L):

· A certified survey is required for home-site requests if the area cannot be described as an aliquot part and if not in a surveyed town site area. Surveys are not provided by this office.

· Occupancy of the home-site is required within 1 year from date of approval of lease. If not, this will be cause for cancellation of home-site lease.

· For home-sites on Tribal land, a survey will be required within 6 months after the Land Committee’s approval. If a certified survey is not provided within this time frame, the Land Authority approval will be null & void and the home-site area will be made available to any other Tribal Member.

· Your signature verifies that you agree to the above stipulations and timelines.

TYPE OF DWELLING TO BE BUILT OR PUT ON PROPOSED LEASE:

Permanent structure (House)

Trailer house

APPROXIMATE AMOUNT OF MONEY TO BE SPENT ON IMPROVEMENTS: $____________

This application will require a Categorical Exclusion (Cat-Ex) which will be submitted to the Regional BIA office. After the Cat-Ex is returned, then the application can be presented to Land Committee for approval.

DATE

SIGNATURE OF APPLICANT