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©2019 by Witset First Nation

#3 - 205 Beaver Rd. Witset, BC V0J 2N1 • 250 847 2133 • Fax: 250 847 9291 

Witset Community Household Update

*for those living on reserve only 

First Name:

Last Name:

Clan:

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Home Phone:

Mobile Phone:

Email Address:

Spouse information

First Name:

Last Name:

Clan:

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Check if not applicable

Mobile Phone:

Email Address:

House Number:

Street  Name:

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Mailing Address:

(if different from residential address)

Are you and/or your spouse? 

Choose your means of communication: (for notification of events within our community)

If not, are you interested in this for your home?

Do you have pet dogs in your household, if yes how many? 

# of dogs:

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Occupant Information

Check if no other occupants reside in the home

Name:

Age:

Name:

Age:

Name:

Age:

Name:

Age:

Name:

Age:

Name:

Age:

Clan:

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Clan:

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Clan:

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Clan:

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Clan:

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Clan:

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Name:

Age:

Clan:

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Name:

Age:

Clan:

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Name:

Age:

Clan:

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Name:

Age:

Clan:

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# of Elders: 

(55 and up)

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# of Adults: 

(19 to 54)

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# of Children: (18 and under)

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VEHICLE(S):

# of Trucks:

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# of Cars:

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# of Vans:

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Questions/Concerns or Comments: