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Change of Address Form

The change of address form is sent to tribal government services for processing. The form applies to voter registration, CDIB, citizenship, the Chickasaw Times and tribal mailers. This form does not update your address with the Chickasaw Nation Department of Health*.

First Name:
Last Name:
Maiden Name:
Email:
Primary Phone Number:
Secondary Phone Number:
Date of Birth:
Chickasaw Citizen?:
Registered Chickasaw Voter?:

Old Address

Address:
City:
State:
ZIP code:

New Address

Physical Address (No P.O. Box):
City:
State:
ZIP code:
I have a different Mailing Address.

Call the tribal government services office at (580) 436-7250 for assistance with this form.

*Department of health patients can update addresses during their pre-registration call prior to any appointment, or when checking in for appointments at any Chickasaw Nation health care facility.

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