Rev g

12/14/2013

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Date________________________

This questionnaire must be filled-out by any public servant/official who wishes to interact with your name or wishes to contract with YOUR NAME or for ANY other purpose engage your name and or his personal property, YOUR NAME

This is not an option but a legal requirement pursuant to the Privacy Act, 5 U.S.C. 552a, 88 Stat. 1896, et seq., 1974.

Public servant's full legal name:___________________________________________________________________ ID / Badge Number:_____________________________________________________________________________ 3. Public servant's home residence address:____________________________________________________________ City, State,Zip:________________________________________________________________________________ Phone: ( ) _______________________________________________________________________________

4. Name of Agency:_______________________________________________________________________________ Agency Address:_______________________________________________________________________________ Address:_____________________________________________________________________________________ City,State,Zip:________________________________________________________________________________ Phone: ( ) _______________________________________________________________________________

Supervisors Name_____________________________________________________________________________ Phone ( ) ______________________________________________________________________________

5. Your Personal / Public Servant Bonding Agency:_______________________________________________________ Bond Number:__________________________________________________________________________________

Common Law, Natural Law, is hereby invoked. The Public Servant is liable for any and all injury to Sovereign. Public Servant is not allowed to presume anything about the Sovereign. Statutes, codes, and regulations do not apply as they have not been nor shall be consented to. Just as The Divine Creator created man, man created the government. The Creator not being subject to man, man is neither subject to the Public Servant, unless a crime has been witnessed and an injured party gives claim. The Sovereign i s As-King until the Creators Son returns. The Slavery Systems that have be perpetuated for hundreds of years, will not be tolerated any longer. Administrators are not Judges and NO EARTHLY JUDGE can judge a man. For the original Bondservant Contract is in place and no 3rd party may intervene.

6. Servant Bonding Agency Address:___________________________________________________________________ City,State,Zip:_________________________________________________________________________________ Phone ( ) _______________________________________________________________________________

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Public Servant Questionnaire

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7. Did you, as a public servant, take an oath to uphold the Constitution of the United States ? Yes or No (Circle One)

8. Will you, as a public servant, uphold the Constitution of the United States? Yes or No (Circle On 9. Will you as a public servant furnish a copy of the law or regulation that authorizes the action being taken or information requested in this case? Yes or No (Circle One) 10. Will you as a public servant provide in writing, that portion of the law authorizing the questions asked? Yes or No (Circle One) 11. Are answers voluntary or mandatory? Voluntary or Mandatory (Circle One)

12. Are you familiar with 18 USC 31 - Definitions (a)(6) ? Yes or No (Circle One) 13. Are the questions being asked based upon a specific law or regulation, or process? ___________________ ______________________________________________________________________________________ 14. What other uses may be made of this information? ____________________________________________ ________________________________________________________________________________________ 15. What other agencies may have access to this information?_________________________________________ _____________________________________________________________________________________ 16. What will be the effect upon me if I should not choose to answer any or all of your questions?____________ ______________________________________________________________________________________
Common Law, Natural Law, is hereby invoked. The Public Servant is liable for any and all injury to Sovereign. Public Servant is not allowed to presume anything about the Sovereign. Statutes, codes, and regulations do not apply as they have not been nor shall be consented to. Just as The Divine Creator created man, man created the government. The Creator not being subject to man, man is neither subject to the Public Servant, unless a crime has been witnessed and an injured party gives claim. The Sovereign i s As-King until the Creators Son returns. The Slavery Systems that have be perpetuated for hundreds of years, will not be tolerated any longer. Administrators are not Judges and NO EARTHLY JUDGE can judge a man. For the original Bondservant Contract is in place and no 3rd party may intervene.

17. Person in government requesting this information: Name:__________________________________________ Location of this Person - State/County/City___________________________________________________ 18. Is this investigation general or special? (Circle One) Note: by general, it means any kind of blanket investigations in which a number of persons are involved because of geography, type of business income, etc. By special, it means any investigation of an individual nature in which others are not involved. 19. Have you consulted, questioned, interviewed, or received information from any third party relating to this matter? Yes or No (Circle One) If yes, give identity of all such third parties: (Use back of sheet if more area is needed.)

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1. _____________________________________________________________________________________________ 2. _____________________________________________________________________________________________ 3. _____________________________________________________________________________________________ 4. _____________________________________________________________________________________________

21. Do you reasonably anticipate either a civil or criminal action to be initiated or pursued based upon any of the information, which you seek? Yes or No (Circle One) 22.Is there a file of records, information, or correspondence relating to me being maintained by this agency? Yes or No (Circle One) 23. Is this agency using any information on me, which was supplied, by another agency or government source? Yes or No (Circle One) 24. Will the public servant guarantee that any other department other than the one by which he is employed will not use the information in these files? Yes or No (Circle One)

Common Law, Natural Law, is hereby invoked. The Public Servant is liable for any and all injury to Sovereign. Public Servant is not allowed to presume anything about the Sovereign. Statutes, codes, and regulations do not apply as they have not been nor shall be consented to. Just as The Divine Creator created man, man created the government. The Creator not being subject to man, man is neither subject to the Public Servant, unless a crime has been witnessed and an injured party gives claim. The Sovereign i s As-King until the Creators Son returns. The Slavery Systems that have be perpetuated for hundreds of years, will not be tolerated any longer. Administrators are not Judges and NO EARTHLY JUDGE can judge a man. For the original Bondservant Contract is in place and no 3rd party may intervene.

Granulations, you have completed the Questionnaire. Please Sign Below I hereby sign and affirm under the penalty of perjury that the answers are true and correct in every particular.

Name public servant printed:______________________________________________________________________

_____________________________________ Signature of public servant Date _______________________

Notice: If any person or agency receives any request for information relating to me, you must advise me in writing before releasing such information. Failure to do so may subject you to possible civil or criminal action as provided by this act or other law(s).
Mail to: Your Name Address Town of City, State [zip]

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For Office Use Only

Did public servant provide proof of identity? Verify Number ______________________________ Was the public servant cooperative ___________________________________________________ TITLE 18 - CRIMES AND CRIMINAL PROCEDURE PART I - CRIMES CHAPTER 13 - CIVIL RIGHTS 241. Conspiracy against rights If two or more persons conspire to injure, oppress, threaten, or intimidate any inhabitant of any State, Territory, or District in the free exercise or enjoyment of any right or privilege secured to him by the Constitution or laws of the United States, or because of his having so exercised the same; or If two or more persons go in disguise on the highway, or on the premises of another, with intent to prevent or hinder his free exercise or enjoyment of any right or privilege so secured They shall be fined not more than $10,000 or imprisoned not more than ten years, or both; and if death results, they shall be subject to imprisonment for any term of years or for life.

Common Law, Natural Law, is hereby invoked. The Public Servant is liable for any and all injury to Sovereign. Public Servant is not allowed to presume anything about the Sovereign. Statutes, codes, and regulations do not apply as they have not been nor shall be consented to. Just as The Divine Creator created man, man created the government. The Creator not being subject to man, man is neither subject to the Public Servant, unless a crime has been witnessed and an injured party gives claim. The Sovereign i s As-King until the Creators Son returns. The Slavery Systems that have be perpetuated for hundreds of years, will not be tolerated any longer. Administrators are not Judges and NO EARTHLY JUDGE can judge a man. For the original Bondservant Contract is in place and no 3rd party may intervene.

 242. Deprivation of rights under color of law Whoever, under color of any law, statute, ordinance, regulation, or custom, willfully subjects any inhabitant of any State, Territory, or District to the deprivation of any rights, privileges, or immunities secured or protected by the Constitution or laws of the United States, or to different punishments, pains, or penalties, on account of such inhabitant being an alien, or by reason of his color, or race, than are prescribed for the punishment of citizens, shall be fined not more than $1,000 or imprisoned not more than one year, or both; and if bodily injury results shall be fined under this title or imprisoned not more than ten years, or both; and if death results shall be subject to imprisonment for any term of years or for life. The compilers of the code were not empowered by congress to amend existing law, and doubtless had no thought of doing so ... ...the act before us does not purport to amend a section of an act, but only a section of a compilation entitled REVISED CODE OF WASHINGTON, WHICH IS NOT THE LAW. Such an act purporting to amend only a section of the prima facie compilation leaves the law unchanged. En Banc. PAROSA v. TACOMA, 57 Wn.(2d) 409 (Dec.22, 1960). RCWs are constitutionally defective, for the following reasons: 1. The Revised Code of Washington Makes No Claim To Be Law 2. The Revised Code of Washington Specifically Disclaims Authority of Law"...Nothing herein shall be construed as changing the meaning of any such laws." RCW 1.04.021 3. The Washington State Supreme Court Has Said It Is Not The Law In this respect, the 1951 legislature was following its own unconstitutional device for Amending a section of an act in disregard of the specific constitutional mandate. The act before us does not purport to amend a section of an act, but only a section of a compilation entitled "Revised Code of Washington," which is not the law. Such an act purporting to amend only a section of the prima facie compilation leaves the law unchanged." PAROSA v. TACOMA, 57 Wn.2d 409, 415, (1960) (emphasis added) It Claims Authority Only By The unratified 1889 Constitution. This Code of Washington is unlawfully Revised By The Executive Branch. The Revised Code of Washington is copyrighted and therefore private. 5. The Revised Code of Washington Has No Enacting Clauses. 6. The Revised Code of Washington Lacks Proper Titles. 18 USC 31 - Definitions (a)(6) Motor vehicle. The term motor vehicle means every description of carriage or other Contrivance propelled or drawn by mechanical power and used for commercial purposes on the highways in the transportation of passengers, passengers and property, or property or cargo.

Common Law, Natural Law, is hereby invoked. The Public Servant is liable for any and all injury to Sovereign. Public Servant is not allowed to presume anything about the Sovereign. Statutes, codes, and regulations do not apply as they have not been nor shall be consented to. Just as The Divine Creator created man, man created the government. The Creator not being subject to man, man is neither subject to the Public Servant, unless a crime has been witnessed and an injured party gives claim. The Sovereign i s As-King until the Creators Son returns. The Slavery Systems that have be perpetuated for hundreds of years, will not be tolerated any longer. Administrators are not Judges and NO EARTHLY JUDGE can judge a man. For the original Bondservant Contract is in place and no 3rd party may intervene.