Professional Documents
Culture Documents
Application For Repatriation and Citizenship
Application For Repatriation and Citizenship
NATIONAL HEADQUARTERS
P.O. BOX 436885
CHICAGO, PROVINCE OF ILLINOIS [60643]
PHONE: 773-359-3192
www.unitedstatesrepublic.us
EMAIL: [email protected]
Appellation/Name:
FIRST NAME MIDDLE NAME LAST NAME. TITLE
NAME AT DELIVERY:
FIRST NAME MIDDLE NAME LAST NAME
DOMICILE:
CITY / STATE / ZIP
MAILING LOCATION:
CITY / STATE / ZIP
TELEPHONE:
Home Business Mobile
EMAIL:
VITAL DATA
1. Race: Nationality:
5. Sex: Age: HT: WT: Hair Color: Eye Color: Blood Type:
USRAP 041504, 29 August 2018 (AD) Supersedes all previous Form 001 page 1 of 4
APPLICATION FOR CITIZENSHIP
Type Diploma/Degree:
Type Diploma/Degree:
Certification/Degree:
EMPLOYMENT / VITEA
Employment:
Address:
City/State/Zip:
Name:
Location: City/State:
1. Date:
2. Date:
3. Date:
4. Date:
5. Date:
6. Date:
7. Date:
8. Date:
9. Date:
As a NATIONAL /Citizen OF THIS NATION, WHAT SKILLS DO YOU HAVE THAT YOU FEEL WILL BE
HELPFUL IN BUILDING OUR NATION AND NATIONAL GOVERNMENT:
TRADE/BUSINESS
Trade/Business Name:
Address:
City/State:
Position/Role:
Website:
Email:
Product(s)/Service(s):
Use back of this page for any additional information:
USRAP 041504, 29 August 2018 (AD) Supersedes all previous Form 001 page 3 of 4
BACKGROUND LEGAL
INFORMATION
Do you have any outstanding legal issues? (Felonies/Misdemeanors or Warrants or Tax Issues):
Do you have a current/valid Driver’s License? If so, which State? If not, please explain
Have you been convicted of any crimes other than traffic violations? If so, please explain
Are there any other legal issues that you care to discuss?
Please be aware that the government cannot provide any legal advice for cases older than 30 days.
USRAP 041504, 29 August 2018 (AD) Supersedes all previous Form 001 page 4 of 4