FOR OFFICIAL USE:

NOTICE OF EXPATRIATION & REPATRIATION

Notice of Declaration of Independence
NOTICE OF RESCISSION OF ALL ADHESION CONTRACTS
NOTICE TO AGENTS IS NOTICE TO PRINCIPALS in their private capacity
NOTICE TO PRINCIPALS IS NOTICE TO AGENTS in their private capacity
Applicable to all Successors and Assigns
SILENCE IS ACQUIESCENCE

From: Declarants herein:

Full Name: [Your Full Name]
Private People on the Land.
c/o
Address: [your street address here]
City: [your city here] State: [your state here] Postal Code: [your postal code here]
The united states of America

To: Respondents herein:

Federal Offices:
Barak H. Obama and the Office of the President of the United States
1600 Pennsylvania Avenue
Washington, D.C. 20500
Timothy F. Geithner and the Office of the Secretary of the Treasury of the United States
1500 Pennsylvania Avenue, N.W.
Washington, D.C. 20220
Gary F. Locke and the Office of the Secretary of Commerce of the United
States Room 5854, US Department of Commerce
14th and Constitution Avenue SW
Washington, D.C. 20230

Raymond H. LaHood and the Office of the Secretary of Transportation

400 7th Street S.W.
Washington, D.C. 205090
Douglas H. Shulman and the Office of the Internal Revenue Service
1111 Constitution Avenue N.W.
Washington, D.C. 20543
John G. Roberts, Jr. and the Office of the Chief Justice of the U.S. Supreme Court
1 First Street N.E.
Washington, D.C. 20543
Hillary R. Clinton and the Office of the Secretary of State of the United States
2201 C Street N.W.
Washington, D.C. 20520
Eric H. Holder, Jr. and the Office of the Attorney General of the United States
950 Pennsylvania Avenue N.W.
Washington D.C. 20530-0001

State Offices: [Your State]

Name and address of The Office of the Secretary of State
Name and address of The Office of the Governor
Name and address of The Office of the Attorney General
Name and address of The Office of the Chief Justice
Name and address of The Office of Director of Trade and Economic Development

VERIFICATION
County: [YOUR COUNTY HERE
State: [YOUR STATE HERE]

)
)
)

VERIFIED DECLARATION

I/We,[Your Full Name], Declarants herein, Private People in the [your state here]
republic, one of the united States of America, state under penalty of perjury under the
Laws of The united States of America and of [your state here] state, that Declarants are

competent to be witnesses and that the facts contained herein are true, correct,
complete, and not misleading, to the best of Declarants firsthand knowledge and belief.

Notice of Declaration of Independence

Respondents, TAKE NOTICE:

That, I/We, [Your Full Name], the Declarants herein, in the name of the Almighty
Creator, by Our Declaration of Independence, solemnly Publish and Declare Our
Political Choice, Will, and Intent.

That, I/We, [Your Full Name], the Declarants herein, under 15 United States Statutes at
Large, titled An Act concerning the Rights of American Citizens in foreign States
passed on the Twenty-seventh Day of July, 1868 A.D. by the Fortieth Congress, Sess.
II. Ch. 249, pages 223 & 224, and under Decisions by the Judiciary, have a Right to
expatriate. (See Exhibit A attached).

That, I/We, [Your Full Name], the Declarants herein, ab initio, do expatriate absolute,
Our res, estates, and all our property in trust to the foreign jurisdiction known as the
municipal corporation of the District of Columbia, a/k/a United States, a/k/a State of
[Your State], a democracy and its laws and are not, and explicitly refuse to be, chattel
property and citizens of the United States.

That, I/We, [Your Full Name], the Declarants herein, have returned and repatriated as
Citizens/Nationals of the [Your State] state republic, and as American Citizens of the
Republic of the united states of America and under their Laws, with all Our estates and
properties, real and personal, tangible and intangible, and barring none, formerly held in
trust with the socialistic United States, a/k/a the District of Columbia and its
instrumentalities for the general I/Welfare and benefit of all citizens of the United States
within the 14th amendment communal public trust.

That, I/We,[Your Full Name], the Declarants herein, state that such property includes,
but is not limited to, all real and personal property previously transferred in error or by
fraudulent registration, to the United States and its instrumentalities, a/k/a the State of
[Your State], regardless of their location within The United States or other countries
foreign to the United States and its territories. Such properties are now declared private
property and under the organic Constitutions are not subject to any form of taxation by
the democracy known as the United States, a/k/a the District of Columbia and its
instrumentalities.

That, I/We, [Your Full Name], the Declarants herein, freely choose and pledge Our
allegiance to the Republic of the united States of America and not to the municipal
corporation called United States, a/k/a District of Columbia, and its instrumentalities.

That, I/We, [Your Full Name], the Declarants herein, refuse to be in rebellion, and do
not and will not commit treason, against the Republic of the united states of America
and will not support enemies of said Republics by voting for Officers and
Representatives of the de facto United States and its instrumentalities, a foreign
corporation with regards to [Your State] state, a republic.

Respondents, TAKE NOTICE:

That, I/We, [Your Full Name], the Declarants herein, state that any and all past and
present political ties implied by operation of law or otherwise in trust with the
democracy, a/k/a the United States, a/k/a the District of Columbia and its
instrumentalities, are hereby severed, rescinded, dissolved, cancelled, and terminated,
for FRAUD AND FAILURE OF FAIR CONSIDERATION, and all benefits, including but
not limited to, benefits of enfranchisement from any country, including the United States,
a/k/a District of Columbia, its agents, agencies, and instrumentalities, are severed,
forfeited, rejected, waived, declined, cancelled, and not accepted, ab initio and nunc
pro tunc.

Respondents, TAKE NOTICE:

That, I/We, [Your Full Name], the Declarants herein, have full power to contract and
establish commerce as guaranteed by the Constitution and the First Ten Articles in
Amendment, a/k/a the Bill of Rights, to the Constitution for The united States of
America, of 1789 A.D. as amended in 1791 A.D., establishing a Republic.
NOTICE OF SEVERANCE, WAIVER, FORFEITURE, AND REJECTION OF ALL
BENEFITS
I/We, [Your Full Name], the Declarants herein, give Respondents, in their private
capacity, and as agents of the United States, a/k/a the District of Columbia and its
instrumentalities, NOTICE OF SEVERANCE, WAIVER, FORFEITURE,
CANCELLATION, AND REJECTION OF ADMIRALTY BENEFITS from the United
States and its instrumentalities, and NOTICE, that any and all hidden and invisible or
adhesion contracts and/or commercial agreements between the United States, a/k/a the
District of Columbia and its instrumentalities, and [Your Full Name], and/or the juristic
persons, [YOUR FULL NAME IN CAPITAL LETTERS] or any derivative name-forms

thereof, are hereby SEVERED, RESCINDED, DISSOLVED, CANCELLED, AND

TERMINATED ab initio and nunc pro tunc, for FRAUD AND FAILURE OF FAIR
CONSIDERATION.

I/We, [Your Full Name], the Declarants herein, give Respondents, in their private
capacity, and as agents of the United States, NOTICE, that any and all benefits
associated with such unrevealed contracts and/or commercial agreements are being
severed, waived, rejected, declined, cancelled, and forfeited, and no benefits, including,
but not limited to Limited Debt Liability Benefits, are being voluntarily accepted by
Declarants, [Your Full Name], and/or the juristic persons, [YOUR FULL NAME IN
CAPITAL LETTERS] or any derivative name-forms thereof.

I/We, the Declarants herein, give Respondents, in their private capacity, and as agents
of the United States, NOTICE, that [Your Full Name], and/or the juristic persons, [YOUR
FULL NAME IN CAPITAL LETTERS] or any derivative name-forms thereof, object to
the 14th amendment to the Constitution for the united states of America of 1789 A.D. as
amended in 1791 A.D., ab initio and nunc pro tunc.

I/We, the Declarants herein, give Respondents, in their private capacity and as agents
of the United States, NOTICE, that [Your Full Name], and/or the juristic persons, [YOUR
FULL NAME IN CAPITAL LETTERS] or any derivative name-forms thereof, have
declared Our status as non-juristic strangers to the public trust created by the 14th
amendment to the Constitution for the United States of America of 1789 A.D. as
amended in 1791 A.D., and that I/We, the Declarants, have voluntarily severed, waived,
rejected, forfeited, declined, cancelled, and refused to voluntarily accept any and all
enfranchisement benefits from the United States and its instrumentalities through
unrevealed or adhesion contracts and/or commercial agreements.

I/We, the Declarants herein, give Respondents, in their private capacity, and as agents
of the United States, NOTICE, that the benefits from the unrevealed or invisible
contracts and/or commercial agreements referred to above include, but are not limited
to, the following: The past Use of:
Social Security Numbers; The U.S. Postal Service; Federal Reserve Notes; Bank
Accounts; Bank, Mortgage, Credit cards and other Loans or credit instruments; All
Licenses, including but not limited to Drivers Licenses; Professional Licenses; Marriage
licenses; A States license plates on cars; Public Schools; Two-letter State abbreviation
and federal zip codes; Birth Certificates; Passports issued by the U.S. Secretary of
State; Internal Revenue Services; Past Voter registrations; U.S. citizenship; Medicaid,
and Medicare benefits, and any and all other unrevealed benefits, barring none.

NOTICE OF RESERVATION OF RIGHT ABINITIO AND NUNC PRO TUNC

I/We, the Declarants herein, give Respondents, in their private capacity, and as agents
of the United States, FURTHER NOTICE that, [Your Full Name], and/or the juristic
persons, [YOUR FULL NAME IN CAPITAL LETTERS] or any derivative name-forms
thereof, pursuant to the Uniform Commercial Code at (UCC) 1-207, ab initio and nunc
pro tunc, reserve Our Right not to be compelled to perform under any contracts and/or
commercial agreements in which I/We did not enter knowingly, intentionally, and
voluntarily, with full disclosure of all facts, meeting of the minds, and mutual exchange
of fair consideration.

I/We, the Declarants herein, give Respondents, in their private capacity, and as agents
of the United States, FURTHER NOTICE that by such Reservation of Right, [Your Full
Name], and/or the juristic persons, [YOUR FULL NAME IN CAPITAL LETTERS] or any
derivative name-forms thereof, have notified all Local, State, and Federal government
agents, agencies, and instrumentalities, that [Your Full Name], and/or the juristic
persons, [YOUR FULL NAME IN CAPITAL LETTERS] or any derivative name-forms
thereof, do not and will not accept the liability associated with the compelled
benefits of such unrevealed contracts and/or commercial agreements, be they
Admiralty or otherwise.

I/We, the Declarants herein, give Respondents, in their private capacity, and as agents
of the United States, NOTICE, that any further Use of Social Security Numbers; The
U.S. Postal Service; Federal Reserve Notes; Bank Accounts; Bank, Mortgage, Credit
cards and other Loans or credit instruments; All Licenses, including but not limited to
Drivers Licenses; Professional Licenses; Marriage licenses; A States license plates on
cars; Public Schools; Two-letter State abbreviation and federal zip codes; Birth
Certificates; Passports issued by the U.S. Secretary of State; Internal Revenue
Services; Past Voter registrations; U.S. citizenship; Medicaid, and Medicare benefits,
and any and all other unrevealed benefits, by [Your Full Name] and/or the juristic
persons, [YOUR FULL NAME IN CAPITAL LETTERS] or any derivative name-forms
thereof, as a compelled benefit from the United States and its instrumentalities, will
not be under any contractual relationship, but will be Without Prejudice under Our
Explicit Reservation of Right at U.C.C. 1-207, whether so claimed at the time of Use or
not.
NOTICE TO RESPOND
I/We, the Declarants, herein, [Your Full Name] give Respondents ten (10) days
from the date of receipt of this NOTICE, to dispute or object to Our Expatriation
from the United States, a/k/a the District of Columbia, a democracy, and its laws,
and Repatriation into the Republic and under its Laws, with Our res and all of Our

estates, real and/or personal, tangible and/or intangible properties, either by error
or fraudulently transferred by registration, to the United States and its
instrumentalities, a/k/a the State of [Your State], or formerly held in trust with the
United States and its instrumentalities, ab initio, for the general I/Welfare and
benefit of all citizens of the United States within the communal 14th amendment
public trust. Such property includes but is not limited to real and personal
property located anywhere within The United States or any country foreign to the
United States and its instrumentalities, and all such property, being private, is
exempt from taxation, under the organic Constitution and , by the de facto United
States and its instrumentalities.
Failure of Respondents to timely dispute and object to Declarants Expatriation from the
United States, a democracy and its laws, and Repatriation into the Republic and its
Laws, with their res and all their estates and properties, tangible and intangible, will be
admission, confession, stipulation, and agreement by Respondents through TACIT
PROCURATION, Stare Decisis, that:
Respondents are at Fault.
Declarants, herein, are non-juristic and natural persons.
Declarants herein, [Your Full Name], have the Right through Their political Choice, Will,
and Intent, to expatriate from the democracy known as the United States and its
instrumentalities, and repatriate into the Republic, known as the united States of
America, with all Their property formerly held in trust for the use and general I/Welfare
of the citizens of the United States, without interference from anyone, as provided by
the Fortieth Congress of the United States, Sess. II, and the Judiciary.
Declarants herein, [Your Full Name], have knowingly, intentionally and voluntarily,
exercised Their Right, and have not only expatriated ab intio from the foreign
jurisdiction known as the municipal corporation of the District of Columbia, a/k/a United
States and its instrumentalities, a democracy and its laws, but; Declarants herein, [Your
Full Name], have repatriated into the Republic and under its Laws, with their res and
all their estates and private properties, real and personal, tangible and intangible.
Declarants properties include but are not limited to real and personal property
located anywhere within The United States or any other country foreign to the
United States and its instrumentalities, transferred in error or fraudulently by
registration, to the United States and its instrumentalities.
Declarants properties, formerly held in trust with the United States and its
instrumentalities, ab initio, for the general I/Welfare and benefit of all the citizens of the
United States within the communal 14th amendment public trust, are no longer subject
to taxation and control by the United States, a/k/a the District of Columbia and its
instrumentalities, including this State, the State of [Your State].

Further Declarants say not.

Given under Our hands and Seals this _____ day of _______________, 2001 A.D.
Submitted Without Prejudice
By: ______________________________
[Your Full Name] Seal:

I hereby certify that on this _____ day of _______________, 2001 A.D., living,
breathing, flesh and blood people, known to me to be [Your Full Name], appeared in
their proper persons to attest and affirm that they are the men and women executing the
foregoing document titled, NOTICE OF EXPATRIATION AND REPATRIATION.
I, THEREFORE, set forth my hand and seal in affirmation of the execution thereof.
______________________________ ____________________
NOTARY PUBLIC Date:
____________________
My Commission Expires Seal
To: The [Your County] County Recorders Office:
After Recording Please Return To:
[Your Full Name]
[Your Address]
[Your City], [Your state], [Your Postal Code]