Document Request Form

							                                             QUECHAN INDIAN TRIBE
                                               Fort Yuma Indian Reservation
                                                             TRIBAL COURT
                                                            Phone: (760) 572-5552
                                                             FAX: (760) 572-5560


                                  Document Request Form
Part A: Your Details

                     Your Full Name [*Note: If your name has changed, previous name(s) used.]



                                             Other Party’s Full Name



                                        Full Name of Minor (s) in the Case



                       Case Number                                       Case Date / Year



Part B: The Document(s) you require

      Copy of Order                    Date Court Order made: __/__/___ Type of Order: ______________

      Copies of documents (Please Specify) _______________________________

      Other (Please Specify) _______________________________________________

Part C: Proof of Identity & Contact Information
  If you require a copy of orders or documents we must see a current driver’s license,
                 passport, student card or other photo ID in your name.

Address                                                          State                      Zip




          Cell Phone                            Home Phone                     Work/Message Phone




Revised: 8/31/2009
Part D: Fees Involved & Method of Payment

       25¢ per page for photocopying of documents

      $1.00 per certified copy (in addition to per page charge)

       $5.00 per CD

Part E: Methods of payment accepted
Payment must be made before document(s) will be released.
      › Money Order for amounts over $5.00 (made payable to: Quechan Tribal Court)
      › Cash accepted for amounts under $5.00

NOTE: PROCESS WILL TAKE 2-3 WORKING DAYS FROM YOUR
                     REQUEST

Part F: Signature



                                                                     Date:   /      /

Part G: (Office Use Only) Release Information

The following is authorized for release:

     Copy of Order      Date Court Order made___/___/____ Type of Order: ____________

     Copies of document(s) __________________________________________________

      Other: ______________________________________________________________
Case Number                       Number of: Pages   CDs   Certificates          Receipt No.


             Signature Authorizing Release                        Date             Time



Signature Acknowledging Receipt


                                                                     Date:   /      /




Revised: 8/31/2009