We The

People
California Republic 1849 state Citizen Identification
Article I. Declaration of Rights
Sec. 2
All political power is inherent in the
people.Government is instituted for
the protection, security, and benefit
of the people; and they have the
right to alter or reform the same,
whenever the public good may
require it.
Thousand

Doc. ID: GMPAESE

Given Name:
Family Name:
Nationality: Californian
Domiciled: California
Republic 1849
Conceived: Seventh
Month Eighth Day in the Year of Our Lord One
Nine Hundred and Sixty Seven.

HT: 6'1" WT: 350 Hair: Brn Eyes: Brn

Expires: Never Class: First
______________________
Witness:

______________________________
Signature:
______________________________
Witness:

state of California
County of_________________)
On________________before me,_____________________________
personally appeared________________________________________
who proved to me on the basis of satisfactory evidence to the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the
same in his/her/their authorized capacity(ies), and by his/her/their signature(s) on the
instrument or person(s), or the entity upon behalf on which the person(s) acted, executed the
instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the
foregoing paragraph is true and correct.
WITNESS my hand of official seal.

Signature__________________________ (Seal)