DECLARATION OF CITIZENSHIP STATUS, Republic of Texas

                                                  Republic of Texas                         
                                DECLARATION OF CITIZENSHIP STATUS
Full Name: ___________________________________________________________
Permanent Address: _____________________________________________________
_____________________________________________________
County: ___________________________________ Phone: ___________________________________
Email: __________________________________ Fax: _______________________________________
Height: __________ Weight: __________ Hair Color: _________ Eye Color: __________ Sex: __________
I, _______________________________________________, hereby affirm that the following facts are true, correct, and
complete according to my personal first-hand knowledge.
I was born in <city>_____________________________ or <county>___________________________________
in <state/republic> _________________________________, <country>________________________________
on <date>___________________________.
I have no disabilities that would prevent me from making this declaration.. I am a sovereign, freeman character, who
does and desires to operate and conduct my affairs under the common law in the Republic of Texas. I am not wanted for
or under indictment for any crime in Texas or abroad under the common law.
I 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 and renounce any such citizenship.
This Declaration is made without deception or for purposes of evasion.
I hereby attest that I will uphold the laws of the Republic of Texas and bear true allegiance to the same.
Citizen’s affirmation: _____________________________________________ Date: ______________________
Witnessed at Law by:
_______________________________________________________________ Date: ______________________
_______________________________________________________________ Date: ______________________
--------------------------- --FOR SECRETARY OF GOVERNMENT USE ONLY----------------------------------------
Date affidavit received/recorded: ____________ Name of recording official: ______________________________
_