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Re: Information Regarding Your 2010 Gaming Revenue Per Capita Payment

Dear Tribal Member:

The Cheyenne and Arapaho Tribes' Gaming Revenue Allocation Plan (GRAP) was adopted pursuant to Cheyenne and Arapaho Tribal Council Resolution No. 011704STC002 dated January 17, 2004. On August 24, 2004, the United States Department of the Interior formally approved the GRAP. Distribution of per capita payments to eligible tribal members is governed by GRAP § III and federal law, 25 C.F.R. §290.12 (b) (4) (2005). This distribution will be made on August 15, 2010 to enrolled tribal members who are at least 18 years of age as of August IS, 2010 pursuant to GRAP § III.C.2.

This Per Capita Payment Is Income Subject to Federal Income Taxation:
Under federal law, this per capita distribution is considered income that is subject to federal income tax. You must report this per capita payment as income not subject to self-employment tax on your federal income tax return. The Tribes will issue an IRS Form 1099-MISC income statement to you by January 31, 2010 if the total gaming per capita distribution made to you in 2010 equals or exceeds $600. These per capita payments are reportable on line 21 of Form 1040, described as:

Indian Gaming Proceeds

Indian Tribal Distrib

Native American Distrib



Federal Income Tax Withholding Information:
Pursuant to the Tribes' GRAP and Internal Revenue Service regulations Section 3402(r), the Cheyenne and Arapaho Tribes must withhold taxes on distributions of Indian gaming profits to Tribal members. In 2010, tax withholding is required if (a) the total payment to a member for the year is over $8,950.00 and (b) the payment is from the net revenues of class II or class III gaming activities (classified by the Indian Gaming Regulatory Act) conducted or licensed by the Tribes (Publication IS-A). There will be no withholding on this payment because the threshold was not met.

You Must Report This Per Capita As Income When Applying For Benefits:
Per Capita payments are considered income, and the amount must be reported if you apply for tribal, state, or federal services or benefits. If you are receiving social security benefits, cashing the Gaming Per Capita check will potentially affect your benefit in an equal amount.

Choosing Not To Receive Taxable Gaming Per Capita Payments:
Some tribal members may choose not to receive this per capita payment because of its effect on benefits (such as social security), enrollment (relinquishing in order to enroll in another tribe), federal taxes, religious conviction, or other reasons. If you do not wish to receive per capita payments of our tribal gaming revenues, you may elect to opt out of the Plan by following these two steps:

I} Provide the Per Capita Administrator with a notarized statement signed by you that declares that you do not wish to receive per capita payments of Cheyenne and Arapaho net gaming revenues. This statement must include the signatures of two witnesses who can vouch for the authenticity of the document.

2} The notice must be mailed to the Per Capita Administrator by certified mail, return receipt requested. You must retain the original return receipt as evidence that the Per Capita Administrator, Department of Treasury, received the notice.

When you choose to opt out of receiving gaming per capita payments, you will have waived any right, vested, or otherwise, in any future per capita payments under this Plan. Choosing not to receive per capita payments of tribal gaming revenues does not affect your tribal membership and your rights to receive per capita payments from other sources, such as oil and gas assets of the Tribes, GRAP § III.E,

Dispute Resolution:
If you have any dispute with the allocation of this per capita payment or your eligibility to receive this per capita payment, you must file a complaint in the Cheyenne and Arapaho District Court, GRAP § III.C.6

Change of Information for 2010:
An Adult Change of Information form & W-9 form is enclosed. The W-9 is a certification that the TIN you are giving is correct (or you are waiting for a number to be issued), that you are not subject to backup withholding, or that you claim exemption from backup withholding if you are an exempt payee. You are required to complete both forms even if you are not changing your address. When both forms are completed, enclose them in the supplied envelope, and mail them to the Per Capita Department.

Thereafter, this will be your address of record until you submit a new change of information. If you have already submitted your current information on the new forms, please retain the blank forms for future use.

The deadline to submit both forms to Per Capita for the August 15, 2010 check run is by close of business, Thursday, July 31, 2010. Your forms must be on file in order for your check to be printed.

If there are any questions or concerns, please contact Per Capita at 405-422-7565 or 405-422 7607 (fax) or write to P.O. Box 146, Concho, OK 73022,


-The Per Capita Department