Gaming Revenue Application

The Klamath Tribes
Member Benefits Department

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

Gaming Revenue is available and distributed in equal amounts as annual per capita payments to enrolled Klamath Tribal Members from the excess net gaming revenues.
Indian Gaming Regulatory Act §2710.3(D), Tribal Gaming Ordinances
Per capita payments are subject to Federal taxation. Therefore, Gaming Revenue applications must include a copy of the applicants Social Security Card unless the Member Benefits Department confirms one is currently on file.

Applicant’s Information

Type N/A if Not Applicable

12.If this application is being submitted on behalf of a minor or adult under guardianship, provide the followinginformation for the person submitting this application:

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

*Must ensure legal documentation showing guardianship is on file.

This document was prepared under the provision of the Revenue Allocation Plan Klamath Tribal Code Title 7 Chapter 50, approved March 11, 2006 by General Council, Revised November 17, 2012.

Click or drag a file to this area to upload.