SECTIO

N
FIVE

TABLE OF CONTENTS
SECTION 5: FORMS & INFORMATION
1.

PRESIDENTIAL EXECUTIVE ORDERS

2.

STRAWMAN/REAL MAN TERMINOLOGY

3.

AFFIDAVIT OF RECORDING - Witnesses (for

online COUNTY RECORDING with only one
Property List in Section 1)

4.

AFFIDAVIT OF RECORDING - Notary version for

above recording

5.

STAMP EXAMPLES (2 pages)

6.

AGENCY MAILING LIST

A. Instruction Sheet
B. Large Labels -- FOR AGENCY MAILINGS (2 PAGES)
C. Small Labels -- ADDRESS LABELS FOR GREEN RETURN

RECEIPT CARDS (2)

PRESIDENTIAL EXECUTIVE ORDERS AND

LAWS
JOHN WARNER NATIONAL DEFENSE AUTHORIZATION ACT
1.
2.
3.
4.

PASSED OCTOBER 17, 2006

VOIDED THE POSSE COMITATUS ACT
ALLOWS FOR MILITARIZED POLICE ROUNDUPS
ALLOWS FOR THE DETENTION OF PROTESTORS, ILLEGAL ALIENS AND
UNDESIRABLES IN FEMA PRISONS

MILITARY COMMISSIONS ACT OF 2006

1.
2.
3.
4.
5.

REMOVES THE RIGHT OF HABEOUS CORPUS

GIVES DICTATOR POWERS TO THE PRESIDENT
ENEMY COMBATANT STATUS CAN BE DECLARED BY AN UNFOUNDED
ACCUSATION
REDEFINES TORTURE AND ALLOWS TORTURE UPON AMERICAN
CITIZENS WHEN ACCUSED OF BEING AN ENEMY COMBATANT
TORTURE MAY BE USED TO THE POINT OF MAJOR ORGAN FAILURE OR
DEATH WITH COMPLETE IMMUNITY FROM PROSECUTION

VIOLENT RADICALIZATION AND HOMEGROWN TERRORISM ACT OF

2007 - HR1955
1.
2.
3.
4.

INTRODUCED BY REPRESENTATIVE JANE HARMON DEMOCRAT FROM

CALIFORNIA
AMENDS PATRIOT ACT TO INCLUDE CIVILIAN POPULATION OF U.S.
MAKES THOUGHTS AGAINST THE POLITICALLY CORRECT IDEAS OF THE
DAY A CRIME
MAKES THOUGHT CRIMES A TERRORIST ACT

REAL ID ACT
1.

U.S. CITIZENS WILL BE REQUIRED TO HAVE A NATIONAL ID CARD TO:

a. TRAVEL
b. ENTER A FEDERAL BUILDING
c. APPLY FOR ANY PUBLIC BENEFIT OR PROGRAM

FOREIGN INTELLIGENCE SURVEILLANCE ACT

1.
2.
3.
4.

ALLOWS SECRET WARRANTS FROM A SECRET COURT TO INVADE YOUR

PRIVACY
FISA TEAMED UP WITH AT&T AND VERIZON COMMUNICATIONS
COMPANIES TO SPY ON U.S. CITIZENS
PHONE CALLS AND EMAILS OF AMERICANS ARE BEING TRACKED
ACCORDING TO DOCUMENTS BROUGHT FORWARD BY MARK KLIEN OF
AT&T
PRIVACY WAS REDEFINED BY BUSH ADMINISTRATION. DEFINITION NO
LONGER MEANS ANONIMITY

5.

BUSH ADMINISTRATION WAS SPYING ON U.S. CITIZENS 7 MONTHS

BEFORE SEPTEMBER 11, 2001

NATIONAL SECURITY ADMINISTRATION

1.
2.
3.
4.
5.

WAS CREATED BY PRESIDENT TRUMAN IN 1952

ANALYZES MILLIONS OF PHONE CONVERSATIONS EACH DAY
COMPILES DATA BASES OF MILLIONS OF U.S. CITIZENS PHONE
CONVERSATIONS
ESTIMATED 38,000 EMPLOYEES AND 43.5 BILLION DOLLARS PER YEAR
BUDGET
WORKS WITH CENTRAL INTELLIGENCE AGENCY, NATIONAL
RECONAISSANCE OFFICE, FEDERAL BUREAU OF INVESTIGATION AND
FISA TO INVADE THE PRIVACY OF U.S. CITIZENS

PRESIDENTIAL EXECUTIVE ORDERS

10990 - POWER TO CONTROL HIGHWAYS, MODES OF TRANSPORTATION
AND SEAPORTS
10995 - POWER TO SEIZE CONTROL OF COMMUNICATIONS, MEDIA
INTERNET, RADIO AND TELEVISION
10997 - POWER TO CONTROL ELECTRICITY, FUEL AND MINERALS
10998 - POWER TO SEIZE ALL MEANS OF TRANSPORTATION, INCLUDING
PERSONAL, CARS, TRUCKS, BOATS AND PLANES, ETC.
10999 - POWER TO SEIZE ALL FOOD SUPPLIES AND FARMS
11000 - ALLOWS GOVERNMENT TO MOBILIZE CIVILIANS INTO WORK
BRIGADES UNDER GOVERNMENT SUPERVISION
11001 - POWER OVER ALL HEALTH, EDUCATION AND WELFARE
FUNCTIONS
11002 - GIVES POSTMASTER POWER TO REGISTER ALL CITIZENS
11003 - POWER TO CONTROL OF ALL PRIVATE AND COMMERCIAL
AIRPORTS AND AIRCRAFT
11004 - ALLOWS THE HOUSING AND FINANCE AUTHORITY TO
RELOCATE COMMUNITIES, BUILD NEW HOUSING AND DESIGNATE
AREAS TO BE ABANDONED
11005 - POWER OVER RAILROADS, INLAND WATERWAYS AND STORAGE
FACILITIES
11921 - GIVES FEMA CONTROL OF BANKS
REFERENCES:
1.
2.
3.
4.
5.
6.
7.
8.
9.

INDYMEDIA.ORG
COMMONDREAMS.ORG
NEWSWITHVIEWS.COM
TRUTHOUT.ORG
TAKEBACKWASHINGTON.COM
OUTTHERETV.COM
MERIA.NET - STREAMING RADIO
1100KNFX.COM
911.ORG

The time is near at hand which must determine whether Americans are to
be free men or slaves. - George Washington

STRAWMAN/REALMAN
TERMINOLOGY
STRAWMAN

Real Man

ALL CAP NAME

Upper Lower Name

SSN With Dashes

SSN No Dashes

ORGANIZATION

Individual

DEBTOR

Secured Party Creditor

BAILEE

Bailor

TRUST

Trustee

GRANTOR

Grantee

CONDUIT
TRANSMITTING UTILITY
JOHN LEE DOE
STRAWMANADDRESS
CITY, STATE ZIP CODE

John Lee Doe

c/o RealManAddress
City, State;
near[RMZipCode]
Non-Domestic without
the US

Section 5 WITNESS VERSION If you do your county recording of the SECTION

1 Freedom Docs online with nationalrepublicregistry.com (NRR), or in a county
other than your residence county, youll then need to record this Affidavit
document in your residence County. (If you move, record one in your new county.)
Call and ask which county office has the Miscellaneous File for Public Record, the
cost to record, & the margin size & how many inches of blank space you need at the
top in order to record a one-page Affidavit. You may need to adjust margins or
retype to reformat & pull line-spacing together in the list so this is all on 1 page.
NOTE: You will get a Liber Number when you record this Affidavit and you will use
THIS Liber # for your documents. If your county refuses to record this (some do &
then someday youll do the Neg. Aver. Process to re-establish a Public Record in that
county), try a neighboring county, or as last resort use the Liber # from your nonresident county filing, in your docs. Do not use the NRR address as a Liber #.
Delete this blue note.

AFFIDAVIT OF RECORDING
On this _________day of ____________, A.D. 20______, for the purpose of
notification, I, the undersigned Secured Party Creditor and three witnesses
located in the County of County and State of State, do solemnly swear or
affirm that Name of Secured Party Creditor recorded this Affidavit of
Recording in the above named County. This Affidavit verifies that the
following documents listed below are recorded at the (Use this following info
if you did an online filing) following website URL for public viewing.
http://www.nationalrepublicregistry.com/public/state.dateNumber,p
df(File Number from NRR Docs) (Or use this following info if you recorded in
a non-resident county) CountyRecordingOffice, RecordingCounty County,
RecordingState, Liber Number.
Number of Pages
1.

CERTIFICATION OF ELECTRONIC RECORDING

(Enter if you used this recording method; otherwise delete)

2.

1
ACKNOWLEDGMENT OF FILING (Enter if you received this for your UCC recording otherwise delete this line)

3.

UCC1

4.

2
ATTACHMENT A - PROPERTY LIST

5.
6.
7.

5
POWER OF ATTORNEY
COMMERCIAL SECURITY AGREEMENT
INDEMNITY BOND/ LIEN

2
4

8.
9.

1
HOLD HARMLESS AND INDEMNITY AGREEMENT
NON-NEGOTIABLE SECURITY AGREEMENT

10.
11.
12.

and

ADDENDUM

1
LEGAL NOTICE AND DEMAND
8
LEGAL NOTICE & DEMAND DEFINITIONS
7
ACT OF STATE with APOSTILLE (Enter what you have . . . Apostille optional, but highly recommended)
2

Signature
Signature
_____________________________________________________
__________________________________________________

Witness Name
Second Witness

First Witness

_____________________________________________________
__________________________________________________
Printed

Witness Name

Printed

Signature
Signature
_____________________________________________________
__________________________________________________
Witness Name
Third Witness
Name, Secured Party Creditor
_____________________________________________________
__________________________________________________
Printed

Secured Party

Printed

Section 5 NOTARIZED VERSION If you do your county recording of the SECTION 1

Freedom Docs online with nationalrepublicregistry.com (NRR), or in a county other than
your residence county, youll then need to record this Affidavit document in your
residence County. (If you move, record one in your new county.) Call and ask which county
office has the Miscellaneous File for Public Record, the cost to record, & the margin size &
how many inches of blank space you need at the top in order to record a one-page Affidavit.
You may need to adjust margins or retype to reformat & pull line-spacing together in the list
so all is on 1 page. NOTE: You will get a Liber Number when you record this Affidavit and
you will use THIS Liber # for your documents. If your county refuses to record this (some do
& then someday youll do the Neg. Aver. Process to re-establish a Public Record in that
county), try a neighboring county, or as last resort use the Liber # from your non-resident
county filing in your docs. Do not use the NRR address as a Liber #. Delete this blue note.

AFFIDAVIT OF RECORDING

On this _________day of ____________, A.D. 20______, for the purpose of

notification, I, the undersigned Secured Party Creditor recorded this Affidavit
of Recording in ____________________COUNTY in the STATE of
________________________________________. This Affidavit verifies that the
following documents listed below are recorded at the (Choose this for online
filing): following website URL for public viewing.
http://www.nationalrepublicregistry.com/public/state.dateNumber,p
df(File Number from NRR Docs) (Or choose this for recording in a nonresident county): CountyRecordingOffice, RecordingCounty County,
RecordingState, Liber Number.
Number of Pages
1.

CERTIFICATION OF ELECTRONIC RECORDING

2.

1
ACKNOWLEDGMENT OF FILING (Enter if you received this for your UCC recording otherwise delete this line)

(Enter if you used this recording method; otherwise delete)

3.

UCC1

4.

2
ATTACHMENT A - PROPERTY LIST

5.
6.
7.

5
POWER OF ATTORNEY
COMMERCIAL SECURITY AGREEMENT
INDEMNITY BOND/ LIEN

2
4

8.
9.

1
HOLD HARMLESS AND INDEMNITY AGREEMENT
NON-NEGOTIABLE SECURITY AGREEMENT

10.
11.
12.

and

ADDENDUM

1
LEGAL NOTICE AND DEMAND
8
LEGAL NOTICE & DEMAND DEFINITIONS
7
ACT OF STATE with APOSTILLE (Enter what you have . . . Apostille optional, but highly recommended)
2

LS:
______________________________________________________________
Real Man Name, Secured
Party Creditor
Date

ACKNOWLEDGEMENT OF
NOTARY
State of ________________________ )

) ss.
County of ______________________ )
On the______ day of_______________, two thousand-nine, before me, _____________________________, Notary,
personally appeared John Lee Doe, known to me (or proved to me on the basis of satisfactory evidence of
identification) to be the living man/woman whose name is subscribed upon this instrument and acknowledged to me
that he/she executed the same in his/her authorized capacity; and by his/her signature on this instrument, John Lee
Doe has acted on behalf of the person who executed this instrument.
Witnessed by my hand and official seal, _____________________________________________
My Commission Expires: _________________________

SEAL

________________STAMPS_______
__________
(COPY & DEFICIENT are TWOtwo2different stamps.) COPY is black & used on the Actual and Constructive
Notice, Birth Certificate Bond, and the International Bill of Exchange in each of the 18-AGENCY packets, & when to
designate papers as a COPY - - could also be red. This COPY stamp is Arial Black in 48-point. DEFICIENT is
ONLY used for Civil cases when sued, NEVER with Criminal cases. Get instructions to use it for court papers.

COPY

On left is FranklinGothicMedium 48 pt. / right is Impact 48pt.

(Arial Black 48 pt. is thick, but more space between letters.)

DEFICIENT
DEFICIENT
STAMP NAME: Envelope Stamp - - - Put on the front of the envelope every time you send a BPN to discharge
public debt.
FONT: Times New Roman 14-point

PRIORITY / CONFIDENTIAL

STAMP NAME: Envelope Stamp - - - Put on the back of the envelope every time you send a BPN to discharge
public debt.
FONT: Times New Roman 14-point

ATTENTION CFO
(Match the Alphabet Letter on the back of your SS card with the following list,
& the corresponding Banks number is your DTC Routing Number)

Federal Reserve Bank Routing Numbers

A - BOSTON - 0110-0001-5
B - NEW YORK - 0210-0120-8
C - PHILADELPHIA - 0310-0004-0

G - CHICAGO - 0710-0030-1
H - ST. LOUIS 0810-0004-5
I - MINNEAPOLIS - 0910-0008-0

D - CLEVELAND - 0410-0001-4
E - RICHMOND - 0510-0003-3
F - ATLANTA - 0610-0014-6

J - KANSAS CITY - 1010-0004-8

K - DALLAS - 1110-0003-8
L - SAN FRANCISCO - 1210-0037-4

STAMP NAME: 7-Line AFV Bill/Presentment/Statement Stamp - - - This closes the account. Discharge the total
amount of the bill. Hand print/write, use from computer, or stamp at a 45-degree angle. Goes on front & back of every
paper. Make no smaller than 10-point print. The following is FONT: Arial 10-point, centered.
ACCEPTED FOR VALUE AND RETURNED FOR VALUE

Stamp is in red.
Use BLUE to fill in.
The Fed. Res. Bank Routing #s are
(with dashes for STRAWMAN)
on the bottom of the last page & are in
the Fed Res Bank Routing Numbers
(Fed. Res. Bank Routing # - file in the EXTRAS folder. Find the bank
See bottom of last page.)
which corresponds with the alphabet
numbers on back of SS card
letter on the back of your SS card. Use
to be a 9-digit number)
that corresponding banks ID# as YOUR
Autograph)
Fed. Res. Bank Routing #.

FOR SETTLEMENT AND CLOSURE

SOCIAL SECURITY NUMBER __________________
DTC ROUTING NUMBER ______________________

DTC ACCOUNT NUMBER _____________________

BY: _____________________________________

(0+8

(Real Man

DATE: _________________________________
STAMP NAME: 6-Line AFV Credit Card Stamp - - - Used to discharge most of the account. This doesnt close the
account. Leave at least $50 in the account so that you dont discharge it completely. Hand print/write, make in the
computer or use a stamp - - - a 45-degree angle, lower left to upper right. Make no smaller than 10-point print. The
following is FONT: Arial 10-point, centered.
Stamp is in red.
ACCEPTED FOR VALUE AND RETURNED FOR VALUE
Use BLUE to fill in.
SOCIAL SECURITY NUMBER __________________
(with
dashes for STRAWMAN)
This stamp is used for
Revolving Lines of Credit.
DTC ROUTING NUMBER ______________________ (Fed. Res.
Bank Routing # - For example: credit cards and
See bottom of last
page.)
bank lines of credit. ALSO
DTC ACCOUNT NUMBER _____________________ (0 + 8
numbers on back of SS card
USE THIS STAMP FOR THE
to be a 9-digit
number)
1040-V FOR SECTION 2 FOR
BY: _____________________________________ (Real Man
Autograph)
THE TREASURY PACKET..may
Need 7 or more lines to fit on 1040-V. DATE: _________________________________
May be best to do by hand or via computer.

************************************************************************
STAMP NAME: AFV Birth Certificate Stamp - - - Hand Print/write, Print by Computer, or Stamp on reverse of birth
certificate for Treasury Packet, lower left to upper right, 45 degree angle. Use a ruler for straight-edge lines.
FONT: Arial 10-point, centered:
NON-NEGOTIABLE CHARGEBACK

Stamp is in red.
Use BLUE to fill in.

OFFICE HOLDER SECRETARY OF THE TREASURY

I ACCEPT FOR VALUE ALL RELATED ENDORSEMENTS IN ACCORDANCE WITH UCC-3-419, HJR192, AND PUBLIC LAW 73-10.
CHARGE MY PRIVATE UCC CONTRACT TRUST ACCOUNT EXEMPTION IDENTIFICATION NUMBER
FOR THE
REGISTRATION FEES AND COMMAND THE MEMORY OF THE FOLLOWING:
Read what the
Fed. Res. Bank Routing #
SOCIAL SECURITY NUMBER ______________________________ (with
Dashes for STRAWMAN)
is in the first small AFV

Stamp sidebar of info

DTC ROUTING NUMBER _______________________________
(Fed. Res. Bank Routing # - above.
See bottom
of last page.)
Youll use this BC stamp once.
DTC ACCOUNT NUMBER ___________________________ (0+8
numbers on back of SS card
Suggestion: print this stamp out
to be a 9digit number)
by hand for the one-time use.
CHARGE THE SAME TO THE DEBTORS ORDER OR YOUR
ORDER.
PRE-PAID COMMON STOCK / PRIORITY / EXEMPT FROM LEVY
BY: ________________________________________________ DATE: _______________________
(Real Man Autograph)

AGENCY MAILING LIST

As a convenience, the following 4 pages have been formatted for printing
labels. The label specifications are as follows:

LABEL BRAND:

Avery

LARGE LABEL MODEL: 5263 (Qty. 250)

LARGE LABEL SIZE:
2 X 4
SMALL LABEL MODEL: 5160 (Qty. 250)
SMALL LABEL SIZE:
1 X 2 5/8
PRINTING INSTRUCTIONS:
1.
2.
3.

Purchase label paper at your local office supply store according to

above specifications.
Insert label paper into your local printer.
Select to print appropriate page numbers of this document for the
large or small labels you want to print out.

HEADS UP!
CAUTION

BEWARE

Before you use address labels on your envelopes with $21.00

postage stamps on them, and the Return Green Cards, check with
your post office because there are some post offices which will no
longer mail a Registered envelope with a stick-on label. The
addresses MUST BE hand addressed because there are too many
incidents where someone is tearing off the labels and the mail
becomes undeliverable. I do NOT understand how this can happen
when a registered mail item needs to be documented with every
connection of delivery/receipt. But people have sent emails saying
their post office will no longer accept Registered Mail items with
labels. So its just something to know about and check before you
use a label and also put the $21 of postage stamps on your
envelopes.
ALSO, a note regarding the PS Form 3811 Green Cards: In #2
(Article Number), always write the label number in this line BEFORE
you put the long, thin, sticky, peel-off number strip in #2. ALSO,
write the number on the other (front) side under United States
Postal Service. The card should be addressed: Your Name, c/o
Notarys Name, c/o Notarys Address, Notarys City State Zip.

ALSO, in #1 along the bottom, black line, put something like: (Your
initials, BPN-006, 10-15-09) so you know which file its for. Check
Registered in #3. Make a copy of front and back before sticking
on envelope & mailing, and upon return.

TIMOTHY F. GEITHNER

SOCIAL SECURITY
ADMINISTRATION

SECRETARY OF THE TREASURY

DEPARTMENT OF THE TREASURY
1500 PENNSYLVANIA AVENUE N.W.
WASHINGTON, D.C. 20220

P.O. BOX 33008

BALTIMORE, MARYLAND 21290-3008

FEDERAL RESERVE
WINDOW

DEPARTMENT OF
TRANSPORTATION

20TH AND CONSTITUTION AVE N.W.

WASHINGTON, D.C. 20551

UNITED STATES SECURITIES

AND EXCHANGE
COMMISSION
COMMISSION HEADQUARTERS
100 F STREET N.E.
WASHINGTON, DC 20549

UNITED STATES SECURITIES

AND EXCHANGE
COMMISSION
RONALD L. CRAWFORD, REGIONAL SECRETARY
OFFICE OF COMPLIANCE INSPECTIONS AND
INVESTIGATIONS
3475 LENNOX ROAD N.E., SUITE 1000
ATLANTA, GEORGIA 30326-1232

DOUGLAS SHULMAN
OFFICE OF THE COMMISSIONER
INTERNAL REVENUE SERVICE
1111 CONSTITUTION AVENUE N W
WASHINGTON, DC 20224

RAY LAHOOD, SECRETARY

1200 NEW JERSEY AVENUE S.E.
WASHINGTON, D.C. 20590

UNITED STATES COURT OF

INTERNATIONAL TRADE
ONE FEDERAL PLAZA
NEW YORK, NEW YORK 10278-0001

UNITED STATES
DEPARTMENT OF
COMMERCE

DENNIS F HIGHTOWER, DEPUTY

SECRETARY
1401 CONSTITUTION AVENUE N W
WASHINGTON, DC 20230

UNITED STATES
DEPARTMENT OF
COMMERCE
OFFICE OF GENERAL COUNCIL
DEPARTMENT OF ASSISTANCE AND FINANCE
LITIGATION
14TH AND CONSTITUTION AVENUE N W
MAIL STOP 5875 HCHB
WASHINGTON, DC 20230

ERIC THORSON

U.S. TREASURY INSPECTOR GENERAL

1500 PENNSYLVANIA AVENUE N.W.
WASHINGTON, D.C. 20220

FRANK Y. NG, OR DESIGNEE

DEPUTY COMMISSIONER
INTERNATIONAL
P.O. BOX 920
BENSALEM, PA. 19020

IVY CHESNEY, OR DESIGNEE

(YOURUCCRECORDINGSTATE) SECRETARY OF
STATE

UCC DIVISION
(ADDRESS)
(CITY, STATE ZIPCODE)

(YOUR RESIDENCE STATE)

NAME - SECRETARY OF
STATE
(ADDRESS)
(CITY, STATE ZIPCODE)

U.S. DEPARTMENT OF
TRANSPORTATION

DIRECTOR OF INTERNATIONAL
OPERATIONS
INTERNAL REVENUE SERVICES
1111 CONSTITUTION AVENUE N.W.
WASHINGTON, D.C. 20224

ASSISTANT GENERAL COUNSEL FOR

ENVIRONMENTAL, CIVIL RIGHTS, AND
GENERAL LAW
ROOM W96-304(C-10), U.S.
M STREET AND NEW JERSEY AVENUE S.E.
WASHINGTON, D.C. 20001

(YOUR RESIDENCE STATE)

DEPARTMENT OF TREASURY

JUAN CARLOS PUIG

MORALES

(NAME OF TREASURER), STATE

TREASURER
(ADDRESS)
(CITY, STATE ZIPCODE)

(YOUR BIRTH STATE)

DEPARTMENT OF HEALTH
AND VITAL STATISTICS
ADDRESS
CITY, STATE ZIP CODE

Internal Revenue Service

DEPARTMENT DE HACIENDA
P.O. BOX 9024140
SAN JUAN, PUERTO RICO 00902-414

First Middle Last

First Middle Last

First Middle Last

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

First Middle Last

First Middle Last

First Middle Last

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

First Middle Last

First Middle Last

First Middle Last

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

First Middle Last

First Middle Last

First Middle Last

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

First Middle Last

First Middle Last

First Middle Last

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

First Middle Last

First Middle Last

First Middle Last

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

First Middle Last

First Middle Last

First Middle Last

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

First Middle Last

First Middle Last

First Middle Last

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

First Middle Last

First Middle Last

First Middle Last

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

First Middle Last

First Middle Last

First Middle Last

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

TIMOTHY F. GEITHNER

SOCIAL SECURITY
ADMINISTRATION

SECRETARY OF THE TREASURY

DEPARTMENT OF THE TREASURY
1500 PENNSYLVANIA AVENUE N.W.
WASHINGTON, D.C. 20220

P.O. BOX 33008

BALTIMORE, MARYLAND 21290-3008

DEPARTMENT OF
TRANSPORTATION

UNITED STATES SECURITIES

AND EXCHANGE COMMISSION

UNITED STATES SECURITIES AND

EXCHANGE COMMISSION

UNITED STATES DEPARTMENT

OF COMMERCE

RAY LAHOOD, SECRETARY

1200 NEW JERSEY AVENUE S.E.
WASHINGTON, D.C. 20590

RONALD L. CRAWFORD, REGIONAL SECRETARY

OFFICE OF COMPLIANCE INSPECTIONS AND
INVESTIGATIONS
3475 LENNOX ROAD N.E., SUITE 1000
ATLANTA, GEORGIA 30326-1232

UNITED STATES DEPARTMENT OF

COMMERCE

COMMISSION HEADQUARTERS
100 F STREET N.E.
WASHINGTON, D.C. 20549

DENNIS F HIGHTOWER, DEPUTY

SECRETARY
1401 CONSTITUTION AVENUE N.W.
WASHINGTON, D.C. 20230

ERIC THORSON

OFFICE OF GENERAL COUNCIL

DEPARTMENT OF ASSISTANCE AND FINANCE
LITIGATION
14TH AND CONSTITUTION AVENUE N.W.
MAIL STOP 5875 HCHB
WASHINGTON, D.C. 20230

U.S. TREASURY INSPECTOR GENERAL

1500 PENNSYLVANIA AVENUE N.W.
WASHINGTON, D.C. 20220

FRANK Y. NG, OR DESIGNEE

(YOUR RESIDENCE STATE)

(NAME), SECRETARY OF
STATE

DEPUTY COMMISSIONER INTERNATIONAL

P.O. BOX 920
BENSALEM, PA. 19020

U.S. DEPARTMENT OF
TRANSPORTATION

ASSISTANT GENERAL COUNSEL FOR

ENVIRONMENTAL, CIVIL RIGHTS, AND
GENERAL LAW
ROOM W96-304(C-10), U.S.
M STREET AND NEW JERSEY AVENUE S.E.

(YOUR BIRTH STATE)

DEPARTMENT OF HEALTH
AND VITAL STATISTICS
ADDRESS
CITY, STATE ZIP CODE

ADDRESS
CITY, STATE ZIP CODE

(YOUR RESIDENCE STATE)

DEPARTMENT OF TREASURY
(NAME) STATE TREASURER

ADDRESS
CITY, STATE ZIP CODE

FEDERAL RESERVE WINDOW

20TH AND CONSTITUTION AVE N.W.
WASHINGTON, D.C. 20551

UNITED STATES COURT OF

INTERNATIONAL TRADE
ONE FEDERAL PLAZA
NEW YORK, NEW YORK 10278-0001

DOUGLAS SHULMAN
OFFICE OF THE COMMISSIONER
INTERNAL REVENUE SERVICE
1111 CONSTITUTION AVENUE N.W.
WASHINGTON, D.C. 20224

(YOUR UCC RECORDING

STATE)
Secretary of State
UCC DIVISION
ADDRESS
CITY, STATE ZIP CODE

IVY CHESNEY, OR DESIGNEE

DIRECTOR OF INTERNATIONAL
OPERATIONS
INTERNAL REVENUE SERVICES
1111 CONSTITUTION AVENUE N.W.
WASHINGTON, D.C. 20224

JUAN CARLOS PUIG MORALES

DEPARTMENT DE HACIENDA
P.O. BOX 9024140
SAN JUAN, PUERTO RICO 00902-414

First Middle Last

First Middle Last

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

First Middle Last

First Middle Last

First Middle Last

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

First Middle Last

First Middle Last

First Middle Last

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

First Middle Last

First Middle Last

First Middle Last

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US

c/o Real Man Street Address

City, State; near [Zip]
Non-Domestic without the US