This web page exists to help individuals that may be entitled to receive distribution of funds awarded to "Jessie Short v. United States" plaintiffs. If you believe that you may be so entitled please fill out the form below and press SEND. Please be as thorough as possible to help us establish your eligibility. The information submitted by this form will be held in strict confidentiality and will only be used for the processing of Requests for Distribution of Jessie Short monies pursuant to order of the United States Court of Federal Claims.

Please note that our court filings requesting payment to Jessie Short plaintiffs or their heirs may be challenged. If that happens we may need further documentation such as your driver’s license, utility bill, or Tribal Identification Card.

If you know of any additional relatives that may have an interest in the Jessie Short Case, they are encouraged to complete this form or contact the Yurok Tribe Office of the Tribal Attorney at the following address:

Yurok Tribe, Office of the Tribal Attorney
Attn: Andrea McCovey
P.O. Box 1027
Klamath, CA 95548

amccovey@yuroktribe.nsn.us

INFORMATION ABOUT YOU
Your Name:
Your Maiden Name, if Applicable:
Email address:
Any Aliases or Former Names you have gone by:
Your Social Secuity Number:
Your Date of Birth:
Your Father's Name:
Your Father's Date of Birth:
Your Father's Date of Death if applicable:
Your Mother's Name:
Your Mother's Date of Birth:
Your Mother's Date of Death if applicable:
Your Current Address:
Your Phone Number:
Your Tribal Affiliation, if Applicable:
Your Tribal Identification Number, if Applicable:

INFORMATION ABOUT THE PLAINTIFF FROM WHOM YOU MAY INHERIT
Name of Jessie Short Planintiff:                           
Plaintiff’s Declaration Number:
Relationship to You:
Date of Birth, if Known:
Date of Death, if applicable:

Comments:   

I understand that by submitting this form and clicking “Send” I am declaring, under pain of criminal penalty as provided in Sections 1001, 1003, 1621 & 1323 of Title 18 United States Code of Knowingly making false statements and that I am the individual identified in the “Your Name” field above and that all the information in this declaration is true and correct to the best of my knowledge and belief.