THE MOORISH NATIONAL REPUBLIC

MOORISH DIVINE AND NATIONAL MOVEMENT OF THE WORLD

Aboriginal and Indigenous Natural Peoples of North-West Amexem North America

Affidavit of Fact
Exhibit <EnterLetter> - Certificate of Service

<Date>

United States Supreme Court of <Republic>

Office of the Clerk
<Address>
<City> Territory, <RepublicName> Republic
[<zip>] uSA

It is Hereby Certified that service of the foregoing, the associated Memorandum of Law,
and the associated Affidavit of Material Facts has been made upon the following
addressee by depositing a copy in the United States Republic mail, postage prepaid,
this ____________ day of __________________, 1430M.C. (2010 C.C.Y.) addressed to:

State Capitol
State of Connecticut Governor
M. Jodi Rell
210 Capitol Avenue
Hartford Territory, Connecticut Republic
[06106] uSA
United States Republic Postmaster Article Number:

State of Connecticut Attorney General

Richard Blumenthal
55 Elm St
Hartford Territory, Connecticut Republic
[06106] uSA
United States Republic Postmaster Article Number:

State of Connecticut Secretary of State

Susan Bysiewicz
30 Trinity St
Hartford Territory, Connecticut Republic
[06115] uSA
United States Republic Postmaster Article Number:

<FreeNationalName>,
Authorized Representative, Natural Person,
In Propria Persona:
All Rights Reserved:
U.C.C. 1-207/ 1-308; U.C.C. 1-103
<IndigenousStateName> Territory
[c/o <MailingLocation>]
[<SubTerritoryName>,<RepublicName> ]
[Zip Exempt]]
Northwest Amexem