Affidavit of Denial of US Citizenship
Affidavit of Denial of US Citizenship
Affidavit of Denial of US Citizenship
To: John F. Kerry dba U.S. SECRETARY OF STATE, and all successors
and assigns (or other public official)
Executed On By:___________________________________
Olivera, Travis Middle
without the UnitedStates
JURAT
A notary public or other officer completing this certificate verifies only the identity of the
individual who signed the document to which this certificate is attached, and not the
truthfulness, accuracy, or validity of that document.
State of Illinois
County of
of___________________20________. by
__________________________________________________.
Proved to me on the basis of satisfactory evidence to be the
person(s)who appeared before me.
Signature ________________________________________