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Home > Registration & Title > Wabanaki Specialty Plate > Wabanaki Certification Form (html format)

State Seal

Department of the Secretary of State

Bureau of Motor Vehicles

Certification of Membership

Wabanaki Confederacy

 

I certify that ____________________________________________________
                        Name Printed or Typed                         Date of Birth

whose address is __________________________________________ is a member
            Address

of the following tribes:   Penobscot, PassamaquoddyMaliseetMicmac Tribe

 

________________________________________________
Signature of Tribal Official              Office held by Official

_______________________________________________
Printed or Typed Name of Tribal Official                 Date

 

 

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