Identification & Warrant Application Form (IWAF)

for the Republic for the united States of America

The form called Declaration of Sovereign Rights held by Indigenous Power (DSR) must be properly
filled out. Such form specific to your free state can be downloaded at www.bureauofrepublicrecords.com on the
free states Documents link. You must submit the DSR along with this completed IWAF Form. This IWAF must be
approved and stamped by your state Governor. This is mandatory in order to process your identification request.

I. Personal Information

Please write legibly in blue or black ink. This .pdf is also fillable.

First / Middle / Last Name

(No unusual punctuation)

Address to be Printed on ID
(Street/ City/ State) No P.O. Boxes.

Mailing Address
(Street/ City/ State & Include Zip)

E-mail Address
Phone 1

Phone 2

Date of Birth (MM / DD/ YYYY)

Place of Birth
(City / State / Country)

Male Female

Sex

Ethnicity

Height (feet / inches)

Weight (lbs)

Color of Eyes

Hair Color

Section I.B. Are you a seated official within

the de jure governing body of the Republic
for the united States of America?
Branch
Position

Yes, Continue below. No, Skip to Section I.C.

Executive Branch
Legislative Branch
Judicial Branch
Law Enforcement
Advisory Board
Other:
Ambassador Congressman Executive Officer Governor Juror
Militia Representative Secretary Senator Other:

Department
Ex. DOE, DOJ, etc.

Section I.C. Were you formerly or currently

enlisted in any Armed Forces or any of the Law
Enforcement Agencies?

Yes, Please describe. No, Skip to Section I.D.

Please describe:
(Branch, Rank, Position,
duties, etc.)

Section I.D. Have you been convicted of or

pleaded no contest to a felony within the last
five years?

Yes, Please explain.

No, Skip to Section II

Please explain:

II. Identification Information (Provide any 2). Documents must be current.

This portion is used for identification verification purposes only. Please provide information and attach copies for ANY 2 of the credentials:

Social Security Number

Passport Number

Drivers License Number

State of Drivers License

Naturalization /Immigration #

Other
Specify:

1)
2)

BRR-IWAF-v.20111802

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III. Types of Identifications & Warrants and Pricing

Types
(Choose package below):

AN = American National Identification Warrant

SID = Free state Citizen Identification
TW = State Travel Warrant (Qualifier: You need to currently

Full descriptions are

available online.

hold a Drivers License to obtain a Travel Warrant)

SID

Choose Either 1:

TW

Cost: $135

Note: American National ID cannot be available without SID or TW.

Choose Any 2:

AN

Choose ALL 3

SID

Cost: $235

TW

Cost: $335

(ALL 3 Identification Warrants)

IV. Payment Confirmation (You must PAY ONLINE in Step 2 under after clicking
Order ID Warrants Tab at www.bureauofrepublicrecords.org.)
Did you receive your
Online Payment
Confirmation?

YES, Please write Confirmation # and attach Receipt of Payment with Form
NO, Sorry we cannot complete your order until payment is confirmed.

Order Confirmation #

Amount Paid

V. Signature / Autograph & Thumbprint

I certify and affirm that all information presented in this application is true and correct. Any documents I have presented herein
are genuine, and that my photograph is a true and accurate representation of how I generally appear in public.

Please sign your Full

Name within the Box
(No unusual punctuations please)
Please do not touch the lines.

Please place your

RIGHT Thumbprint in the
Box on the right.

Sample of
Thumbprint:

Your thumbprint
goes here:

(Use Red, Blue or Black Ink)

Upload a scanned copy of this completed and approved IWAF Registration, your signed Declaration of
Sovereign Rights and Receipt of Payment by clicking on the Browse button found on STEP 3 of the online
Order Page. Be sure to follow the online instructions on how to name your files.

VI. Digital Photograph

Guidelines
Click on the Browse button found on STEP 3
of the online Order Page to attach your photo.
Provide a scan or digital photo of yourself.
Your photo must be:
In color and resolution is at least 300dpi (dots per in.) for good image quality
In either of these accepted formats: .jpg, .tif, .bmp, .pdf, .psd, .eps
Taken within the past 6 months, showing your current appearance
Full face (from mid-chest), front view with a plain white/ off-white background
Taken in normal street attire (no uniforms or sunglasses, no hats or
headgear)
NOTE: Please make sure file size is under 2MB. Please
follow online instructions on how to name your files.
Also, please check your spelling and accuracy. We will not
be responsible for typos, etc. Refer to website for complete
Terms and Conditions.

BRR-IWAF-v.20111802

Official Use Only

free state Governors Section
Officiating
State

Date Received
Governors
Name (Print)
Approved?

Governors
Official Seal of
Approval,
Signature and
Date

Yes (Place seal and signature below)

No, why?

Signature__________________________ Date___________

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