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Unformatted text preview: burned passports, police report required.
___________________________________ __________________ ___________________
Cancelled & Returned
Name in which issued
DO NOT SIGN APPLICATION UNTIL REQUESTED TO DO SO BY AN AUTHORIZED OATH-ADMINISTERING OFFICIAL
OATH AND SIGNATURE : I have not, since acquiring Palau citizenship, been naturalized as a citizen of a foreign state other than the United States; taken oath, or
made affirmation or other formal declaration of allegiance to a foreign state (other than the United States); accepted or performed the duties of any office, post, or
employment under the Government of a foreign state or political subdivision thereof (other than the United States); made a formal renunciation of nationality. I
disclaim nationality in any state or country other than the Republic of Palau and the United States, that may have accrued to me through the nationality of my parents or
for any other reason whatsoever and I hereby renounce absolutely and entirely all allegiance and fidelity to any foreign province...
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This document was uploaded on 02/10/2014.
- Fall '14