MOORISH SCIENCE TEMPLE The Divine and National Movement of North America, Inc. No. 13 The Moorish American National Republic NATIONAL HEADQUARTERS

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1 MOORISH SCIENCE TEMPLE The Divine and National Movement of North America, Inc. No. 13 The Moorish American National Republic 1 NATIONAL HEADQUARTERS Post Office Box Baltimore, Maryland Phone: Fax: APPLICATION FOR MOORISH AMERICAN CITIZENSHIP NOTE: PLEASE PRINT OR TYPE CLEARLY. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. PLEASE INCLUDE COLOR COPY OF BIRTH C ERTIFICATE, SOCIAL SECURITY CARD, DRIVER S LICENSE, TWO PASSPORT PHOTOS AND A COPY OF YOUR COURT ORDER IF YOU HAVE A COURT ORDERED NAME. ALL COURT ORDER NAMES WILL BE PRINTED AS AKA ON YOUR CERTIFICATE OF REGISTRATION. PLEASE PRINT. CHILDREN UNDER 13 - NO PROCESSING FEE NAME AT BIRTH : CURRENT NAME USED: MAIDEN NAME: FIRST MIDDLE LAST [Paperwork to substantiate change MUST be included] i.e., Court Order, etc ADDRESS: CITY/STATE/ZIP:_ Mailing Address: (If different than above): Street: City/ State/Zip: : Telephone: Home:, Bus: Cell: APPLICANT S SIGNATURE: _DATE: APLLICATIONS ARE NOT RETURNABLE. DO YOUR READING, ATTEND OUR SUNDAY CALL. MAKE SURE YOU ARE IN THE RIGHT PLACE, BECASUE YOU ARE :-) NATURALIZATION PROCESSING FEE IS $ (AGES 13 AND ABOVE) - FEES NOT REFUNDABLE. WE ACCEPT ONLY UNITED STATES POSTAL MONEY ORDERS. MAIL APPLICATION TO ADDRESS ON AUDIT SHEE. T. FEE INCLUDES P A Y M E N T F O R ONE MOORISH SCHOOL OF LAW AND HISTORY COURSE. YOUR APPLICATION MUST BE ACCOMPANIED WITH YOUR REGISTRATION FORM FOR ONE OF THE MOORISH S C H O O L O F LAW AND HISTORY COURSES ( A Warning by the Prophet to the Nations"; BE IT KNOWN, or the Nationality and Identification Card Course ) PRIOR to participating in a NATURALIZATION CEREMONY. ALL APPLICANTS ARE REQUIRED TO TAKE ALL THREE MOORISH SCHOOL OF LAW AND HISTORY COURSES IN TOTAL FOR FULL CITIZENSHIP. For further questions please contact Sheikess Annette Bellamy-Bey, at , or at: mnrofficeofregistrarsecretary@gmail.com SHEIKESS ANNETTE BELLAMY-BEY, NATIONAL REGISTRAR...And ye shall hallow the fiftieth year and proclaim liberty throughout all the land unto all the inhabitants thereof. It shall be a Jubilee unto you, and ye shall return every man unto his possession and ye shall return every man unto his family.. CHARTER WARRANT AND DISPENSATION NO CS# Articles of Incorporation ID D Office of Secretary of State Baltimore, Maryland Affidavit Form 1099-SS# Copy Book Page Cook County - Chicago, Illinois August 1@ 2:52PM 1 Form 1099 Act 6

2 2 DATA SHEET 1. Social Security Number: Front: Back: 2. Driver s License Number: Exp.:_ 3. Date of Birth : Country of Birth: 4. City and State of Birth: 5. SEX: AGE: HT: HAIR CLR: _EYE CLR BLOOD TYPE EDUCATION 1. High School? Yes No From: to: Name of High School: If No, do you have a GED? Yes No, Date of Certificate: 2. College? Yes No From: to: Name of College: 3. Vocational/Trade School: Yes No From to: Name of Vocational/Trade School: 2

3 EMPLOYMENT 3 1. Place of employment: Address/City/State/Zip: Phone: Supervisor s Name: 2. How long employed: From _to, Salary: 3. Describe your position: BACKGROUND 1. Do you consent to a background check? Yes No. Have you ever been arrested? Yes No, Type? 2. Have you ever been arrested for any offense involving domestic violence? Yes No 3. Have you ever been convicted of a crime? Yes No, Date: 4. Have you ever been adjudicated mentally incompetent? Yes No, If so when, Where? 5. Have you ever been convicted of a felony Yes No, If so when?, Where? 6. Have you ever been convicted of any offense involving the use of alcohol or drugs? Yes No If so when?, Where? 7. Have you ever been convicted of any offenses involving moral turpitude, i.e., theft, shoplifting, sexual crimes, etc., Yes No, Which one? 8. Are you licensed to carry a weapon? Yes No Type?: Certificate Number 9. Comments: MILITARY RECORD 1. Have you ever been in the military? Yes No, From: to 2. Branch? Rank: 3. How long? Date of Discharge:, Type of Discharge? 4. Are you currently serving or participating with a Military Reserve Unit? Yes No 5. What Branch of the Reserves? 3

4 LIFETIME CERTIFICATES, AWARDS AND HONORS RECEIVED 1. Date: 2. Date: 3. Date: 4. Date: 5. Date: 6. Date: 7. Date: 8. Date: 9. Date: AS A CITIZEN OF THIS MOORISH GOVERNMENT WHAT SKILLS DO YOU HAVE THAT YOU FEEL WILL BE HELPFUL IN THE BUILDING OF THE MOORISH NATION? MOORISH SCIENCE TEMPLE AFFILIATION Temple Name/No. Grand Sheik City/State/Zip WARNING If any person(s), group(s) or companies claiming to represent the Moorish Science Temple The Divine and National Movement of North America, Inc., #13 The Moorish American National Republic in any way, and offering to sell you such things as the Application for Moorish American Citizenship/ Naturalization paperwork, passports, diplomatic appointments and papers, titles of nobility, doctorates or other educational titles, business or banking, licenses, driver's licenses, diplomatic motor vehicle license plates, tax shelters, tax ID cards, and the like, etc., PLEASE CONTACT the Moorish National Marshall Bureau of Investigation at IMMEDIATELY. VIOLATORS WILL BE PROSECUTED T O THE FULLEST EXTENT OF THE LAW. National Grand Sheik Joel Bratton-Bey, Solicitor General 4

5 SELF AUDIT SHEET Please read the check list below to make sure that you have completed all the necessary tasks to submit your application for processing. Money Order for $ is enclosed; Pay To Order Of: 5 MOORISH SCIENCE TEMPLE Fee does not apply to children under 13 years old. [ALL FEES NON-REFUNDABLE] Two (2) Color Passport Sized Photos are included, taken with Tall Maroon Fez with 12 inch Black Tassel [male], White Turban [female]. NOTE: Males wear their 12 inch Black Tassel on the left side for picture; White Turban with ALLAH pin if you have one for the females. Please print your name on back of each picture. The attire for the Naturalization Ceremony is all WHITE. Sisters must wear WHITE Turbans: Brothers must wear their Maroon Fez. Sister s heads must be totally covered. 4. Court Orders pertaining to change of name are enclosed (if applicable). 5. CLEAR COPY of Birth Certificate is enclosed. 6. CLEAR COPY of Drivers License [color copy] is enclosed. 7. CLEAR COPY of Social Security Card [color copy] [FRONT AND BACK] 8. PLEASE SEND APPLICATION AND ENCLOSED DOCUMENTS TO: Moorish American National Republic Moorish National Bureau of Vital Statistics Sheikess Annette Bellamy-Bey National Registrar Post Office Box Baltimore, Maryland Inquiries Contact: Sheikess Annette , mnrofficeofregistrarsecretary@gmail.com, Tues., Wed., & Thurs., - 11:00 a.m. - 4:00 p.m. 10. NOTE: PLEASE ONLY SEND COLOR COPIES OF THE REQUESTED DOCUMENTS NO ORIGINALS. SEND ORIGINAL PASSPORT PICTURES ONLY! PLEASE PRINT YOUR NAME ON BACK OF PICTURE. * Signature *PLEASE CALL NATIONAL REGISTRAR TO FIND OUT IF YOUR MOORISH TITLE IS EL OR BEY. YOUR MOORISH TITLE OF EL OR BEY WILL BE ANNEXED TO YOUR NAME GIVEN AT BIRTH ON YOUR NATIONALITY AND IDENTIFICATION CARD. PLEASE CALL: SHEIKESS BELLAMY-BEY, NA- TIONAL REGISTRAR AT FOR INQUIRIES ON YOUR MOORISH TITLE....And ye shall hallow the fiftieth year and proclaim liberty throughout all the land unto all the inhabitants thereof. It shall be a Jubilee unto you, and ye shall return every man unto his possession and ye shall return every man unto his family.. 5 CHARTER WARRANT AND DISPENSATION NO Articles of Incorporation ID D Office of Secretary of State Baltimore, Maryland Form 1099-SS# Copy Book Page Cook County - Chicago, Illinois August 1@ 2:52PM