Organized Village of Kake

P.O. Box 316

Kake, Alaska 99830-0316
Telephone 907-785-6471
Fax 907-785-4902/www.kake-nsn.gov
(Federally Recognized Tribal Government serving the Kake, Alaska area)

*APPLICATION FOR RESCUE RELIEF FOR HOUSEHOLD ASSISTANCE

**INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED**
PLEASE EMAIL: ca@kake-nsn.gov
In accordance with Section 602(c)(1)(A) CFR Part 35 ARPA, The Organized Village of Kake is able to provide
financial assistance to tribal households that qualify.
- Qualifications: 1) Head of Household 2) 18 or older 3) enrolled with OVK on or before April 6, 2021
- Complete applications will have: 1) A signature, date, address, and phone number 2) An invoice that
demonstrates your residency

Amount eligible for: $1,000 for January 2023/February 2023 ($500/month)

Deadline: February 28, 2023

Name
Mailing Address
Contact phone
Email Address

Full Name Relationship to applicant

READ BEFORE SIGNING

By signing this document, I authorize the release of information from other organizations to The Organized
Village of Kake. All information will be used for the sole purpose of ARPA funding. Applicants and
recipients who knowingly and willfully provide false or fraudulent information are subject to prosecution
under 18 U.S.C. § 1001, the Federal Law concerning fraud which carries a fine of not more than $10,000
or imprisonment of not more than five (5) years or both. I am impacted by Covid-19 yes____
no____

Applicant Signature Printed Name Date

Received By
Date Received
App Number
Check Request complete