Affidavit of Complaining Victim of a Felony
VIOLATION OF: 42 USC 408 A-8 From: [your name]
(8) discloses, uses, or compels the disclosure of the social security All rights reserved. Also see UCC 1-308
number of any person in violation of the laws of the United States; In care of postal service address
or [your address]
(9) conspires to commit any offense described in any of
paragraphs (1) through (4),
shall be guilty of a felony and upon conviction thereof shall be
fined under title 18 or imprisoned for not more than five years, or
both, ….
To: United States Department of State To: Attorney General Sessions
2201 C St NW U.S. Department of Justice
Washington, DC 20520 950 Pennsylvania Avenue, NW
Washington, DC 20530-0001
(1) It is a fact that: That I am natural born State Citizen of [your state], in its constitutional capacity, as one of the
several states of the Union.
(2) It is a fact that: That I am not a United States citizen or resident, nor have I ever been.
(3) It is a fact that: I retain all of my rights always and forevermore. Also see UCC 1-308.
(4) It is a fact that: The United States Department of State has caused me to disclose my Social Security number to
them against my will. See… 42 USC 408 A-8
(5) It is a fact that: There is no constitutional law that requires a State Citizen to have a Social Security number.
(6) It is a fact that: It is a felony to cause me to disclose a Social Security number. See… 42 USC 408 A-8 discloses,
uses, or compels the disclosure of the social security number of any person in violation of the laws of the United
States; or (9) conspires to commit any offense described in any of paragraphs (1) through (4), shall be guilty of a
felony and upon conviction thereof shall be fined under title 18 or imprisoned for not more than five years, or both,
….
(7) It is a fact that: That I have been denied my constitutional right to privacy.
"The State cannot diminish rights of the people." Hertado v. California, 110 U.S. 516
(8) It is a fact: "Where rights secured by the Constitution are involved, there can be no rule making or legislation which
would abrogate them." Miranda v. Arizona, 384 U.S. 436 (1966),
// Date:
[your name]
Notary Public
State of
County of
On this the day of , , before me, , the undersigned officer, personally appeared
, known to me (or satisfactorily proven) to be the person whose name is/are subscribed to the within instrument and
acknowledged that he/she/they executed the same for the purposes therein contained. In witness whereof I hereunto set my hand and official seal.
Notary Public
Printed Name:
My Commission Expires: