Please Fill Out and Send with Your

Name Declaration Correction and Judicial Notice and Proclamation Lawful Documents to be
SEALED

PLEASE SCRIPT LEGABILLY

Nom Deguerre [Current ‘name’]:

Moorish American National

Appellation:

Born Date

In Care of Mailing Location:

Email Address:

Phone Number:

Emergency Contact Appellation:

Next of Kin Contact Number
Mail this Form along with a photo and your Name Declaration Correction and Judicial Proclamation
lawful documents to be Sealed to:

Check the moorishamericanconsulate.org website to find

your local Territorial Consul for mailing location.

For questions are concerns please send email to MoorishAmericanConsulate@gmail.com

This document is for Moorish nationality, not for national identification cards.

Please do not forget to include 35 frns [NO MONEY ORDERS] for sealing and signatures to
include recording with the Moorish American Consulate your nationality status with record
number. If you cannot send 35 please send what you can.

‘We Are Family’

UPLIFTING FALLEN HUMANITY

www.MoorishAmericanConsulate.org – MoorishAmericanConsulateNE@gmail.com