U.S, Department of State BUREAU OF CONSULAR AFFAIRS OATH/AFFIRMATION OF RENUNCIATION OF NATIONALITY OF UNITED STATES Embassy of the United States of America (Eimbassy/Consulate) ss 2 national of the United States. solemnly swear/affimm that | was born at Baghdad ; of Towr) Baghdad : mag O77" 12-02-1957 Province or County Bate o Coury Date mm aainaa That | formerly resided in the United States at 1817 North Broadway ‘Greet adress Crest Hill, linois 60435 (Oly, Sate and 21° Code) That | am a national of the United States by virtue of Birth in United States or Abroad to U.S. Parents) EE] Naturalization Date of Naturalization 12-08-1988 Dale maT (if naturalized, give the name and place ofthe court inthe United States before which naturalization was Granted) United States District Court Northern District of Illinois arm of Court 219 S. Dearborn Street (Steet Aeros Chicago, Ilinois 60604 (Ci, Sate and ZIP Cod) | desire and hereby make a formal renunciation of my U.S. nationality, as provided by section 349(a)(5) of the Immigration and Nationality Act of 1962, as amended, and pursuant thereto, | hereby absolutely and entirely renounce my United States nationality together with all righis and privileges and all duties and allegiance and fidelity thereunto pertaining. | make this renunciation intentionally, voluntarily, and of my own free will, free of any duress or undue influence. f Lido [aa j—— : (Siarture) Subscribed and evornatimedto before methis 222 cayot MAAC 2.0/0 at the ___Embassy of the United States of America Helsinki, Finland (Embassy/Consulate) (ice) Ciaralare oF Fea SEAL Typed Name of Offer) Tite of Oca Note: A renunciation of United States nationaiity/citzenship is effective only upon approval by the U.S. Department of State but, when approved, the loss of nationailty/citizenship occurs as of the date the above OattvAffirmation ‘was taken. Dea0e0 Paget ort 05-2008,