Declaration of Political Status

I the living woman, Jane Marie Dooly (nee Doe), affirm and declare that I have returned to my lawful birthright political status as an Hawaiian, and I claim my exemptions as stated in Federal Code 8 USC 1101 (a) 21.

This I declare and affirm under penalty of perjury under the public law of 
The United States of America.

_________________________________________
by: Jane Marie Dooley (nee Doe) ©
All Rights Reserved
Without Prejudice

Notary Witness and Acknowledgement
Washington
King County

Today before me, a Commissioned Notary, is the living woman known to me to be Jane Marie Dooley (nee Doe) and she did issue this Declaration of Political Status as shown and she also affirmed her testimony as shown before me this ____day of November in the year 2020, in Witness whereof I set my Signature and Seal:
_________________________________ Public Notary; my commission expires on: ________________.

Please note this requires a raised seal or embossed seal notary.  Ideally you can obtain from your assembly but if not, try Land Title companies, public libraries, or a law office.
Cut and paste the appropriate notary block.  Change all words to black once you have modified the template.

If you use the Assembly Recording Secretary use the following Witness Block

Washington State Assembly Recording Secretary Witness 
I,_______________________________ a Your State Assembly Recording Secretary, hereby affirm that the Declarant has been positively identified and I have witnessed their autograph of the Declaration of Political Status:    	 	 

Washington Assembly Recording Secretary

__________________________________________

If you use the Assembly Notary use this Witness Block 

Washington State Assembly Public Notary Witness 
I,_______________________________ a Your State Assembly Public Notary, hereby affirm that the Declarant has been positively identified and I have witnessed their autograph of the Declaration of Political Status:    	 	 

Washington Assembly Public Notary__________________________________________

My Office Commission Expires on _________________________________________