Republic of Texas
AFFIDAVIT OF CITIZENSHIP INFORMATION AND DECLARATION
Full Name
Height:_______ Weight:_______ Hair Color:_______ Eye Color:_________
Sex:_________
Date of Birth:_______________ Address:___________________________________ city of
Domicile:________________________________________________
county of Domicile:________________________________________ district of
Domicile:________________________________________________
I, _______________________________________, hereby affirm the following facts are true,
Correct and complete, according to my personal first hand knowledge.
1.1 was born in city_____________________________,county____________________________
state/republic_________________________________,country____________________________
on date_________________________________.
2.1 currently reside in ____________________________________, County, Texas.
3.1 have no disabilities which would prevent me from making this affidavit.
4.1 am a sovereign, freeman character, who does and desires to operate and conduct my affairs
under the Common Law in the Republic of Texas.
5.1 have never knowingly, intentionally or voluntarily, become a citizen of any de facto nation or
corporate entity, and hereby revoke all powers of attorney with any State, nation or corporate
entity, towit, I hereby renounce any such citizenship.
6.1 am not wanted for or under indictment for any crime in Texas or abroad under the Common Law.
7. This Affidavit is not made under threat, duress or coercion and without deception for purposes of evasion.
8. This affidavit is made pursuant
to the General Provisions, Section 6 of the Constitution for the Republic
of Texas,
as amended August 29,1994.
9. If any part of this Affidavit is found to be fraudulent, it will be null and void and I will be
subject to prosecution under all applicable law.
10.1 hereby attest that I will support and defend the Constitution and Laws of the Republic of Texas.
Date: _____________________ Citizen signature:_________________________________
Witnessed at Law by:
signature:_____________________________________
signature:_____________________________________
-FOR OFFICIAL USE ONLY-
Affidavit received and recorded:___________________________ Name of recording
official:_________________________________
Property Identification Number:___________________________ Signature of recording
official:_________________________________