Affidavit of Citizenship and Domicile
county of ___________________
North-Carolina American Republic
KNOW ALL MEN BY THESE PRESENTS: I,_____________________________________________,
Sui Juris, having first-hand knowledge of the facts as stated herein, hereinafter “affiant”, do hereby declare my
proper and lawful status with respect to Citizenship and Domicile, to-wit:
Your affiant’s natural birth occurred in _________________________________________________state,
on the ________________________ day of ________________________________, 19 _________.
Your affiant has been an Inhabitant of North-Carolina from ____________________________, 19 ______
until the present.
Your affiant clearly understands the difference between a “state Citizen” and a “United States citizen;
your affiant is not a federal “U.S. citizen”.
(a) “We have in our political system, a government of each of the several states and a government of
the United States. Each is distinct from the other