SANNEX (AA). I, A.B, of (insert abode), being originally a citiza of the Uaited States of Ameriea (or a British subject), and having tbecome naturalized withia the dominions of Her Britennic Mojesty av a British subtject (or as a citizen within the United States Sof America), do hereby renounce my natu4ralizarion as a British subject (or citizen of tike United States); and declare that it is my desire to resome my nstionaiity as a Soitizen of the United States (or British subCject.) (Signed) 4. B. Mode and subscribed before me, in (insert couniry or other subdivision, and state, province, colony, lgation, or consulate), Seihis day ot , 187. v e(Sigsed) E. F., CJustic2 of the Peace (or o:her title). (L 5.) EDWD TEORNTON. (L.S.) HAMILTON FISH.