MOORISH SCIENCE TEMPLE
The Divine and National Movement of
North America, Inc. No. 13
The Moorish American National Republic
_____________________________________________
NATIONAL HEADQUARTERS
Post Office Box 23408Baltimore, Maryland 21203
Phone: 410-662-9280 - Fax: 410-662-9281
mstofamnrinc13@verizon.net
APPLICATION FOR MOORISH AMERICAN CITIZENSHIP
NOTE: PLEASE PRINT OR TYPE CLEARLY. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. PLEASE INCLUDE
COLOR COPY OF BIRTH CERTIFICATE, SOCIAL SECURITY CARD, DRIVERS LICENSE, TWO PASSPORT PHOTOS AND A
COPY OR YOUR COURT ORDER IF YOU HAVE A COURT ORDERED NAME. ALL COURT ORDER NAMES WILL BE
PRINTED AS AKA ON YOUR CERTIFICATE OF REGISTRATION. PLEASE PRINT.
CHILDREN UNDER 13 - NO PROCESSING FEE
NAME AT BIRTH :______________________________________________________________________________________
FIRST
MIDDLE
LAST
CURRENT NAME USED:_____________________ __________________________________________________________
[Paperwork to substantiate change MUST be included] i.e., Court Order, etc
MAIDEN NAME: _______________________________________________________________________________________
ADDRESS:______________________________________________________________________________________________
CITY/STATE/ZIP:_______________________________________________________________________________________
Mailing Address: (If different than above): Street: ______________________________________________
City/ State/Zip:___________________:______________________________________________________
Telephone: Home:______________________, Bus:_______________________ Cell: __________________
EMAIL _____________________________________________________________________ __________
APPLICANTS SIGNATURE: ________________________________________DATE: _______________________________
NATURALIZATION PROCESSING FEE IS $125.00 (AGES 13 AND ABOVE)FEES NOT REFUNDABLE. WE ACCEPT ONLY
UNITED STATES POSTAL MONEY ORDERS. MAIL APPLICATION TO ADDRESS ON AUDIT SHEET. FEE INCLUDES A
PORT FOLIO OF HONORABLE PROPHET NOBLE DREW ALIS EXPRESSED WORKS AND ONE MOORISH LAW AND HISTORY COURSE. YOUR APPLICATION MUST BE ACCOMPANIED WITH YOUR REGISTRATION FORM FOR ONE OF THE
MOORISH LAW AND HISTORY COURSES. ALL APPLICANTS ARE REQUIRED TO TAKE ALL THREE MOORISH LAW AND
HISTORY COURSES: A Warning by the Prophet to the Nations; BE IT KNOWN and the Nationality and Identification Card
Course, PRIOR to participating in a NATURALIZATION CEREMONY. For further questions please contact Sheikess Annette Bellamy
-Bey, at 410-488-6858, or email at: mnrofficeofregistrarsecretary@gmail.com
SHEIKESS ANNETTE BELLAMY-BEY, NATIONAL REGISTRAR
____________________________________________________________________________________________________________________________________
...And ye shall hallow the fiftieth year and proclaim liberty throughout all the land unto all the inhabitants thereof. It shall be a Jubilee unto you, and ye shall
return every man unto his possession and ye shall return every man unto his family..
__________________________________________________________________________________________________________________________________
CHARTER WARRANT AND DISPENSATION NO. 1099CS# 06-02-1997-5
Articles of Incorporation ID D06438428Office of Secretary of StateBaltimore, Maryland
Form 1099-SS#10105905 - Copy Book 521 - Page 579 - Cook County - Chicago, Illinois - 1928- August 1@ 2:52PM
Form 1099Act 6
APPLICATION FOR MOORISH AMERICAN CITIZENSHIP
2
DATA SHEET
1.
Social Security Number: Front: ______________________Back:__________________
2.
Drivers License Number: _______________________________Exp.:______________
3.
Date of Birth :___________________Country of Birth:_________________________
4.
City and State of Birth:___________________________________________________
5.
SEX: _____ AGE:____
HT: _______HAIR CLR: _____EYE CLR______BLOOD TYPE_____
EDUCATION
1.
High School? Yes ___ No ___ From:_________________ to: ___________________
Did you graduate? ___Yes ___No Date of Graduation: _______________________________
Degree:_______________________________________________________________________
Name of High School:____________________________________________________________
Address: City/State/Zip:__________________________________________________________
If No, do you have a GED? Yes___ No___ , Date of Certificate:__________________________
2.
College? Yes ___ No ___ From: ______________________to: ___________________
Did you graduate? ___Yes ___No Date of Graduation:_________________________________
Degree:_______________________________________________________________________
Name of College: _______________________________________________________________
Address: City/State/Zip:__________________________________________________________
3.
Vocational/Trade School: Yes ___ No ___ From___________ to: ________________________
Did you graduate? ___Yes ___No Date of Graduation:_________________________________
Degree:_______________________________________________________________________
Name of Vocational/Trade School:_________________________________________________
Address: City/State/Zip:__________________________________________________________
APPLICATION FOR MOORISH AMERICAN CITIZENSHIP
3
EMPLOYMENT
1.
Place of employment: _____________________________________________________________
1Address/City/State/Zip: __________________________________________________________________
Phone: __________________Supervisors Name:______________________________________________
2.
How long employed: _______ From __________to ___________,
Salary: ___________________
3.
Describe your position: ___________________________________________________________________
BACKGROUND
1.
Do you consent to a background check? __yes __No. Have you ever been arrested? Yes____ No ___ ,
Type? _________________________________________________________________________________
2.
Have you ever been arrested for any offense involving domestic violence? Yes___ No _
3.
Have you ever been convicted of a crime? Yes ___ No ___, Date: _______________________________
4.
Have you ever been adjudicated mentally incompetent? Yes ___ No ___,
If so when ________________________________, Where? ___________________________________
5.
Have you ever been convicted of a felony Yes ___ No ___,
If so when? ______________________________, Where? _____________________________________
6.
Have you ever been convicted of any offense involving the use of alcohol or drugs?
Yes ___ No ___ If so when? ____________________________, Where? _________________________
7.
Have you ever been convicted of any offenses involving moral turpitude, i.e., theft,
shoplifting, sexual crimes, etc., Yes ___ No ___,
8.
Are you licensed to carry a weapon?
Which one?_____________________________
Yes ___ No ___ Type?: __________________________
Certificate Number _____________________________________________________________________
9.
Comments: ____________________________________________________________________________
MILITARY RECORD
1.
Have you ever been in the military?
Yes ___ No ___ ,
From: _____________to ______________
2.
Branch?_____________________________________ Rank: _____________________________________
3.
How long? ______ Date of Discharge:_______________, Type of Discharge?______________________
4.
Are you currently serving or participating with a Military Reserve Unit? Yes ___ No ___
5. What Branch of the Reserves?_______________________________________________
3
APPLICATION FOR MOORISH AMERICAN CITIZENSHIP
4
LIFETIME CERTIFICATES, AWARDS AND HONORS RECEIVED
1.
___________________________________________________Date:________________
2.
___________________________________________________Date:________________
3.
___________________________________________________Date:________________
4.
___________________________________________________Date:________________
5.
___________________________________________________Date:________________
6.
___________________________________________________Date:________________
7.
___________________________________________________Date:________________
8.
___________________________________________________Date:________________
9.
___________________________________________________Date:________________
AS A CITIZEN OF THIS MOORISH GOVERNMENT WHAT SKILLS DO YOU HAVE THAT YOU FEEL
WILL BE HELPFUL IN THE BUILDING OF THE MOORISH NATION?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________________________________
MOORISH SCIENCE TEMPLE AFFILIATION
Temple Name/No_______________________________________________________________
Grand Sheik: __________________________________________________________________
City/State/Zip:__________________________________________________________________
WARNING
If any person(s), group(s) or companies claiming to represent The Moorish
Science Temple The Divine and National Movement of North America, Inc.,
#13 The Moorish American National Republic in any way, and offering to
sell you such things as the Application for Moorish American Citizenship/
Naturalization paperwork, passports, diplomatic appointments and papers,
titles of nobility, doctorates or other educational titles, business or banking
licenses, driver's licenses, diplomatic motor vehicle license plates, tax shelters, tax ID cards, and the like, etc., please contact the Moorish Bureau of
Investigation at: 410-662-9280, or the Office of the National Secretary at 954
-722-1941, IMMEDIATELY. VIOLATORS WILL BE PROSECUTED TO
THE FULLEST EXTENT OF THE LAW.
Grand Sheik Joel Bratton-Bey, Solicitor General
APPLICATION FOR MOORISH AMERICAN CITIZENSHIP
5
SELF AUDIT SHEET
Please read the check list below to make sure that you have completed all the necessary task
to submit your application for processing.
1.
___
Money Order for $125.00 is enclosed; Pay To Order Of: MOORISH SCIENCE TEMPLE
Fee does not apply to children under 13 years old. [ALL FEES NON-REFUNDABLE]
2.
___
Two (2) Color Passport Photos are included taken with Red Fez [male] White Turban
[female]
NOTE: Moors wear their Tassel the left side; Turban with ALLAH pin if you
have one. Please print your name on back of each picture.
3.
___
The attire for the Naturalization Ceremony is all WHITE. Sisters must wear WHITE
Turbans; Brothers must wear their RED Fez. Sisters heads must be totally covered.
4.
___
Court Orders pertaining to change of name are enclosed (if applicable).
5.
___
CLEAR COPY of Birth Certificate is enclosed.
6.
___
CLEAR COPY of Drivers License [color copy] is enclosed.
7.
___
CLEAR COPY of Social Security Card [color copy] [FRONT AND BACK]
8.
___
PLEASE SEND APPLICATION AND ENCLOSED DOCUMENTS TO:
Moorish American National Republic
Moorish National Bureau of Vital Statistics
Sheikess Annette Bellamy-Bey National Registrar
Post Office Box 23408Baltimore, Maryland 21203
9.
___
Inquiries Contact : Sheikess Annette Bellamy-Bey @ 410-488-6858, Email
mnrofficeofregistrarsecretary@gmail.com, Tues., Wed., & Thurs., - 11:00 a.m.4:00 p.m.
10.
NOTE: PLEASE ONLY SEND COLOR COPIES OF THE REQUESTED DOCUMENTS NO ORIGINALS. SEND
ORIGINAL PASSPORT PICTURES ONLY! PLEASE PRINT YOUR NAME ON BACK OF PICTURE.
*___________________________________________________________________________________
Signature
*PLEASE USE RED MEDIUM MARKER
TO SIGN YOUR NAME WITH YOUR MOORISH
TITLE OF EL OR BEY ON YOUR NATIONALITY AND IDENTIFICATION CARD. PLEASE CALL:
SHEIKESS BELLAMY-BEY, NATIONAL REGISTRAR AT 410-488-6858 FOR INQUIRIES ON YOUR MOORISH
TITLE.
_________________________________________________________________________________________________________
...And ye shall hallow the fiftieth year and proclaim liberty throughout all the land unto all the inhabitants thereof. It shall be a Jubilee unto you, and ye shall return
every man unto his possession and ye shall return every man unto his family..
______________________________________________________________________________________________________________________________________
