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Get DS-4081 2013

T: I, 1. I have the right to renounce/relinquish my United States nationality. 2. I have the intention of relinquishing my United States nationality. 3. I am exercising my right of renunciation/relinquishment freely and voluntarily without force, compulsion or undue influence placed upon me by any person. Upon renouncing/relinquishing my U.S. nationality, I will become an alien with respect to the United States, subject to all laws and procedures of the United States regarding entry and co.

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