Burial Assistance Application

The Klamath Tribes
Member Benefits Department

501 Chiloquin Boulevard
PO BOX 436
Chiloquin, OR 97624
Phone: (541) 783-2219 | Fax: (541) 783-7768

Burial Assistance is available for enrolled deceased Klamath Tribal Members for Wake Service and/or Funeral Service.

Application Process

Submit the completed Burial Assistance application as soon as possible to begin the approval process. In order to complete the approval process, the Member Benefits Department must receive the business’ current-year W-9, itemized invoice, and a copy of the Certificate of Death.

Deceased’s Information

Applicant’s Information

Please provide contact information for the person completing this form.

Business Information

In order to receive payment for services, the business must provide a current-year W-9.

10. By signing this document, I certify that the information provided is accurate and true to the best of my knowledge

Click or drag a file to this area to upload.