CHECK LIST FOR
HOMESITE LEASE APPLICATION
(USE BLACK INK TO FILL OUT APPLICATION / NO WHITEOUT)
Incomplete application will not be accepted.
1. Required Clearance by the Applicant:
A. Rural / Grazing Areas:
1. Contact your local Chapter Grazing Official and Land Board Member.
2. Grazing Official or Land Board Member fills out Homesite Field Clearance Certification (FORM-
3. Obtain consent from Grazing Permit holder(s) per Field Clearance Certification (FORM-CON06).
4. Submit to Navajo Land Department with all supporting documents.
CHECK LIST BEFORE SUBMITTING TO NAVAJO LAND DEPARTMENT
Attach an updated original Certificate of Indian Blood (Can be obtained from the Agency Census Office).
A non-refundable $15.00 money order for filing fee is attached. Money order payable to:
Navajo Nation, PO Box 9000, Window Rock, AZ 86515.
CATEGORICAL EXCLUSION EXCEPTION REVIEW (CEER), AS PER 43 CFR PART 46
Biological Review: A non-refundable $32.50 money order for “Request for Data/Species of Concerns”
is required from Navajo Fish & Wildlife Department payable to Navajo Nation.
Environment Assessment Form must be completed and attached to the
homesite application. National Environmental Policy Act (NEPA) Compliance is Federal Requirements
to process homesite lease.
The Consent Form (FORM-CON06) must be signed or thumb print with two witnesses upon submission
of Homesite Lease Application at your Agency Navajo Land Offices.
Signature(s), name(s), census number(s), and age on the Homesite Lease Application
corresponds with the information shown on the Certificate of Indian Blood.
Joint Applicants, check choice of Co-Tenancy and sign FORM-JT06.
Location on map must show direction to exact location of the proposed homesite (To be drawn by
applicant) and acknowledged by Grazing or Land Board Official with Geographic Position Systems
(GPS) coordinates. FORM-HSLA06.
Field Clearance Certification Form (FORM-FCC06) filled out and acknowledged by the Grazing
Official or Land Board Member. FORM-FCC06.
Consent Forms signed by Grazing permit holder(s) and acknowledged by the Grazing Official or Land
Board Member. FORM-CON06.
PLEASE SUBMIT THE COMPLETED APPLICATION TO CORRECT AGENCY
NAVAJO LAND OFFICE.
Chinle Land Office, PO Box 2179, Chinle, AZ 86503
Crownpoint Land Office, PO Box 948, Crownpoint, NM 87313
Ft. Defiance Land Office, PO Box 2249, Window Rock, AZ 86515
Shiprock Land Office, PO Box 208, Shiprock, NM 87420
Tuba City Land Office, PO Box 3309, Tuba City, AZ 86045
NOTE: An Archeological Clearance, Biological Review and Navajo Environmental Review are required to
process Homesite Lease Package. For more information contact your local Agency Navajo Land Office or