Fillable Form DS-4081 STATEMENT OF UNDERSTANDING RENUNCIATION OF U.S. NATIONALITY

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Form DS-4081 STATEMENT OF UNDERSTANDING RENUNCIATION OF U.S. NATIONALITY

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The Form DS-4081 STATEMENT OF UNDERSTANDING RENUNCIATION OF U.S. NATIONALITY form is 2 pages long and contains:

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  • 10 check-boxes
  • 12 other fields

Country of origin: US
File type: PDF

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The US Department of State (DOS) or the State Department, is the government official division that advises the President and performs international relations. Equivalent to the outside service of different nations, it was built up in 1789 as the country's first official department.

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U. S. Department of State
Bureau of Consular Affairs
I,
,
understand that:
I have the right to renounce/relinquish my United States nationality.
1.
I am exercising my right of renunciation/relinquishment freely and voluntarily without force, compulsion or
3.
undue influence placed upon me by any person.
4. 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 control of aliens.
5.
If I do not possess the nationality/citizenship of any country other than the United States, upon
my renunciation/relinquishment I will become a stateless person and may face extreme difficulties traveling
internationally and entering most countries and maintaining a place to reside.
6. If I am found to be deportable by a foreign country, my renunciation/relinquishment may not prevent my
involuntary return to the United States.
My renunciation/relinquishment may not affect my military or selective service status, if any. I understand that
any problems in this area must be resolved with the appropriate agencies.
7.
My renunciation/relinquishment may not affect my liability, if any, to prosecution for any crimes which I may
have committed or may commit in the future which violate United States law.
8.
My renunciation/relinquishment may not exempt me from United States income taxation. With regard to
10.
United States taxation consequences, I understand that I must contact the United States
nationality is determined by the United States Attorney General to be motivated by tax
avoidance purposes, I will be found excludable from the United States under Immigration and
Nationality Act, as amended.
12.
the (Vice) consul
at the American
Embassy/Consulate General at
. I fully understand its
consequences.
Name (Typed)
choose to make a separate written explanation of my reasons for renouncing/relinquishing
that I have:
do
do not
my United States nationality.
I: swear had read to meread
The extremely serious and irrevocable nature of the act of renunciation/relinquishment has been explained to me by
I:
this statement in the
Internal Revenue Service. Further, I understand that if my renunciation of United States
DS-4081
05-2017
STATEMENT OF UNDERSTANDING CONCERNING THE CONSEQUENCES AND
RAMIFICATIONS OF RENUNCIATION OR RELINQUISHMENT OF U.S. NATIONALITY
I have the intention of relinquishing my United States nationality.
2.
My renunciation/relinquishment may not affect my liability for extradition to the United States.
9.
Upon renouncing/relinquishing my U.S. nationality, I will no longer be able to transmit U.S. nationality to my
children born subsequent to this act.
language and fully understand its contents.
11.
affirm
Page 1 of 2
Signature
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signature
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CONSULAR OFFICER'S ATTESTATION
appeared personally and:
had read to him/herread
this statement after my explanation of its meaning and the consequences of renunciation/relinquishment of United States
nationality and signed this statement:
under oath by affirmation before me this
day of
,
Consul of the United States of America
(Month) (Year)
(Day)
SEAL
Page 2 of 2DS-4081
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Form DS-4081 STATEMENT OF UNDERSTANDING RENUNCIATION OF U.S. NATIONALITY

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Completed 21 February 2020

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