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    AC Affidavit of Status

    Uploaded by

    Keke LeBron
    The document is an affidavit of denial of U.S. citizenship and nationality signed by an individual named First Middle Last. In the affidavit, the individual states that they are not and have never been a U.S. citizen or national. The individual demands proof within 3 days if anyone claims they are a citizen or national. The affidavit is signed, dated, and notarized.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    AC Affidavit of Status

    Uploaded by

    Keke LeBron
    318 views1 page
    The document is an affidavit of denial of U.S. citizenship and nationality signed by an individual named First Middle Last. In the affidavit, the individual states that they are not and have never been a U.S. citizen or national. The individual demands proof within 3 days if anyone claims they are a citizen or national. The affidavit is signed, dated, and notarized.

    Original Title

    AC Affidavit of Status (2)

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    The document is an affidavit of denial of U.S. citizenship and nationality signed by an individual named First Middle Last. In the affidavit, the individual states that they are not and have never been a U.S. citizen or national. The individual demands proof within 3 days if anyone claims they are a citizen or national. The affidavit is signed, dated, and notarized.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    318 views1 page

    AC Affidavit of Status

    Uploaded by

    Keke LeBron
    The document is an affidavit of denial of U.S. citizenship and nationality signed by an individual named First Middle Last. In the affidavit, the individual states that they are not and have never been a U.S. citizen or national. The individual demands proof within 3 days if anyone claims they are a citizen or national. The affidavit is signed, dated, and notarized.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    Affidavit of Denial of U.S. Citizenship & U.S.

    National
    To John F. Kerry d/b/a/ U.S. Secretary of State and all his successors and assigns or other public
    officials. w
    I, Family Name (aka last name), Given Name (aka first name) beneficial owner First Name,
    Middle Name Last Name d/b/a/ FIRST MIDDLE LAST (ALL CAPS TRUST) hereby and
    forever state, claim and declare I am not nor have I ever been a U.S. citizen. Let it be known by
    all Immigration clerks and securities of states for now and forever I am not nor will I ever be a
    U.S. citizen or U.S. national. You have 3 days to bring forth your proof that I am one.
    I declare under the penalty of perjury under the laws of the United States of America the
    foregoing is true and correct.
    I have hereunto set my hand seal of office on this, _______ Day of ___________, 2016

    Executed by:_____________________________
    First, Last d/b/a Last, First Middle
    without the United States

    JURAT
    State
    County

    )
    ) affirmed and subscribed
    )

    Subscribed and sworn to (or affirmed) before me on this _______ day of ______________

    by ______________________________________, proved to me on the basis of satisfactory


    evidence to be the individual who appeared before me.

    _________________________________
    (Signature of notarial officer)
    (SEAL)

    _________________________________
    Printed Name

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