BRR-IWAF-v.20111802 Page 1 of 2

Identification & Warrant Application Form (IWAF) for the Republic for the united States of America

The form called Declaration of Sovereign Rights held by Indigenous Power (DSR) must be properly filled out. Such form specific to your free state can be downloaded at www.bureauofrepublicrecords.com on the

free states Documents link. You must submit the DSR along with this completed IWAF Form. This IWAF must be approved and stamped by your state Governor. This is mandatory in order to process your identification request.

I. Personal Information Please write legibly in blue or black ink. This .pdf is also fillable.

First / Middle / Last Name (No unusual punctuation)

Address to be Printed on ID (Street/ City/ State) No P.O. Boxes.

Mailing Address (Street/ City/ State & Include Zip)

E-mail Address

Phone 1 Phone 2

Date of Birth (MM / DD/ YYYY) Place of Birth (City / State / Country)

Sex Male Female Ethnicity

Height (feet / inches) Weight (lbs)

Color of Eyes Hair Color

Section I.B. Are you a seated official within the de jure governing body of the Republic for the united States of America?

Yes, Continue below. No, Skip to Section I.C.

Branch Executive Branch Legislative Branch Judicial Branch Law Enforcement Advisory Board Other:

Position Ambassador Congressman Executive Officer Governor Juror Militia Representative Secretary Senator Other:

Department Ex. DOE, DOJ, etc.

Section I.C. Were you formerly or currently enlisted in any Armed Forces or any of the Law Enforcement Agencies?

Yes, Please describe. No, Skip to Section I.D.

Please describe: (Branch, Rank, Position, duties, etc.)

Section I.D. Have you been convicted of or pleaded no contest to a felony within the last five years?

Yes, Please explain. No, Skip to Section II

Please explain:

II. Identification Information (Provide any 2). Documents must be current. This portion is used for identification verification purposes only. Please provide information and attach copies for ANY 2 of the credentials:

Social Security Number Passport Number

Drivers License Number

State of Drivers License

Naturalization /Immigration #

Other Specify:

1)

2)

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III. Types of Identifications & Warrants and Pricing

Types

(Choose package below):

AN = American National Identification Warrant

SID = Free state Citizen Identification

TW = State Travel Warrant (Qualifier: You need to currently hold a Drivers License to obtain a Travel Warrant)

Full descriptions are available online.

Choose Either 1: SID TW Note: American National ID cannot be available without SID or TW.

Cost: $135

Choose Any 2: AN SID TW Cost: $235

Choose ALL 3 (ALL 3 Identification Warrants) Cost: $335

IV. Payment Confirmation (You must PAY ONLINE in Step 2 under after clicking Order ID Warrants Tab at www.bureauofrepublicrecords.org.)

Did you receive your Online Payment Confirmation?

YES, Please write Confirmation # and attach Receipt of Payment with Form NO, Sorry we cannot complete your order until payment is confirmed.

Order Confirmation #

Amount Paid $

V. Signature / Autograph & Thumbprint I certify and affirm that all information presented in this application is true and correct. Any documents I have presented herein are genuine, and that my photograph is a true and accurate representation of how I generally appear in public.

Please sign your Full Name within the Box (No unusual punctuations please) Please do not touch the lines.

Please place your RIGHT Thumbprint in the Box on the right. (Use Red, Blue or Black Ink)

Sample of Thumbprint:

Your thumbprint goes here:

Upload a scanned copy of this completed and approved IWAF Registration, your signed Declaration of Sovereign Rights and Receipt of Payment by clicking on the Browse button found on STEP 3 of the online

Order Page. Be sure to follow the online instructions on how to name your files.

VI. Digital Photograph Guidelines

Official Use Only free state Governors Section

Click on the Browse button found on STEP 3 of the online Order Page to attach your photo. Provide a scan or digital photo of yourself. Your photo must be: In color and resolution is at least 300dpi (dots per in.) for good image quality In either of these accepted formats: .jpg, .tif, .bmp, .pdf, .psd, .eps Taken within the past 6 months, showing your current appearance Full face (from mid-chest), front view with a plain white/ off-white background Taken in normal street attire (no uniforms or sunglasses, no hats or

headgear) NOTE: Please make sure file size is under 2MB. Please follow online instructions on how to name your files. Also, please check your spelling and accuracy. We will not be responsible for typos, etc. Refer to website for complete Terms and Conditions.

Date Received

Officiating State

Governors Name (Print)

Approved?

Yes (Place seal and signature below) No, why?

Governors Official Seal of Approval, Signature and Date

Signature__________________________ Date___________

Full Name: Address to Print: Mailing Address: E-mail: Phone 1: Date of Birth: x1: x2: Height: Eyes: Phone 2: Place of Birth: Ethnicity: Weight: Hair: x3: x4: x5: x8: x16: x11: x17: x12: x6: x9: x18: x13: x7: x10: Other Branch: x14: x15: Other Position: x20: x19: Department: Description: Social Security: Driver's License: Other ID1A: Other ID2A: Naturalization / Immigration Number: Other ID1: Passport Number: State of Driver's License: exlaination: Other ID2: x21: x22: x101: x102: x23: x29: x35: x24: x30: x25: x31: x32: x28: x34: x40: x42: x41: Amount Paid: Payment Confirmation: x38: xx201: