HAWAIIAN CITIZENSHIP DECLARATION

	I am 
_______________________________________________, 
( ) a descendant of the indigenous people of 
Hawaii.
( ) a descendant of a Hawaiian citizen prior to 
January 16, 1893.
( ) born in Hawaii.
( ) a person who has maintained Hawaii as his only 
residence for the five years immediately preceding 
this declaration of Hawaiian Citizenship and who 
has met all of the Hawaiian naturalization 
requirements.

	I hereby declare my citizenship in the 
sovereign and independent nation of Hawaii and in 
so doing, pledge my political allegiance to the 
nation of Hawaii and renounce my citizenship in 
any and every other nation of the world.

	Taking into account the present foreign power 
under which Hawaii is now ruled and aware of the 
unnatural state of social, political, economic and 
legal affairs under which I and my fellow citizens 
must contend as a Hawaiian citizen living under 
said rule, citizens such as myself must operate 
with great discretion in order to bring about the 
full liberation of Hawaii and all her people.  
Therefore, my conduct during this period of 
liberation will be dictated by the reality of our 
conditions created by the  United States of 
America.

	I request that this declaration be 
	( ) held in confidence only with 
______________________ and not to be made a matter 
of public record.
	( ) made a matter of public record to anyone 
who may have a proper purpose of inquiry.

	Dated:  ________________, Hawaii   
____________ ____, 199__.



__________________________________
Signature of:(print) -
_______________________________


Reviewed, accepted and logged by 
_______________________________.
Date:

Verification of eligibility made by: 
____________________________

REGISTRATION NO.  001:92,000,____