RIGHT click here for the Word 97 version of this document

This letter is intended as a response to the IRS when they send you a threatening letter in response to your submission of a W-4 EXEMPT.  In their threatening letter, they will most commonly try to assess an illegal "false statement" penalty of $500 for submitting your W-4, and not document the basis for determining that it is false.  They will also notify you that they have contacted your employer and ordered them to withhold at "single zero" rate.


<<CITY>>, <<STATE>> <<ZIP>>




Directed personally to:

Internal Revenue Service

Fresno Customer Service Center

Questionable W-4 Program
P.O. Box 24015, Mail Stop 813
Fresno, Calif (93776)
Attn:  _________________
Phone:  ________________


(1)     My Request to Stop Withholding dated June 11, 2001; Certified Mail # 700-1530-004-2347 for Navy and Marine Corps Reserve Center.

(2)     My Request to Stop Withholding dated June 11, 2001; Certified Mail #700-1530-004-2347-5159 to Space and Naval Warfare System Center San Diego, Calif.


(1)      Your 2775(CG) Letter to me dated June 11, 2001 (attached)

SubjectAssessment of $500 penalty for False Statement on a W-4 Form

Dear ___________,


Your unsigned and unverified letter of Enclosure  (1) as received by me on 25 JUNE 2001 is REFUSED for cause, on the grounds of fraud.  I wish to appeal your findings and your assessment of penalty.  In the event you are unwilling to honor my  request to eliminate the penalty documented in this letter and the request to notify my employer to stop withholding as I requested, then I demand an immediate Appeals Conference to establish your right to assess the penalties and violate my Fifth Amendment rights by overruling my wishes to stop withholding.

In your letter, you stated as a general conclusion that:

“The law requires the IRS to charge a $500 civil penalty for making a false statement about withholding.  We will charge you the $500 penalty unless you provide reasonable basis for the statements on your Form W-4 within 30 days from the date of this letter.”

However, you have not provided me with any specific statutes and regulations providing evidence to support your erroneous conclusions that there was an alleged “false statement”.  In Refs. (1) and (2), which you completely and frivolously and recklessly disregarded, I provided an affidavit which exhaustively explained why I have no tax liability.  I am still waiting for you to address the issues raised in said references and your lack of a response establishes your acquiescence to their validity.  You are moving against me on mere allegation and without addressing the issues raised in Refs. (1) and (2), which clearly violates my right of due process under the Sixth Amendment to the U.S. Constitution and violations your authority as a revenue officer employed with the IRS.  You have not specifically identified what fact or statement contained on the W-4 constitutes a “false statement” and I challenge your authority and your jurisdiction to assess a penalty for such an undocumented and unexplained violation.   Accordingly:

"To lay with one hand the power of government on the property of the citizen, and with the other to bestow it on favored individuals.. is none the less robbery because it is.. called taxation." Loan Association v. Topeka, U.S. Supreme Court, 1874.

As you are aware, W-4 Forms are voluntary agreements between the employer and the employee that cannot be interfered with by the IRS.  W-4 Forms for private employers and employees have never been memorialized into law.  Your actions are unlawful interference with my right to contract:

INTERNAL REVENUE MANUAL 5337 (1) “Since there is not requirement upon private employers, States or political subdivisions to withhold and pay over amounts under a payroll deduction agreement, the employer must accept the assignment executed by the employee before an agreement is finalized.”

Any act by an IRS officer directing my employer to change my withholding status to other than that which I designate can subject you to a constitutional tort suit.  Participation by my employer may subject the employer to a suit on the grounds of, “conspiracy to violate constitutional rights” under 42 U.S.C. 1983-“Civil Action for Deprivation of Rights” and 18 U.S.C. 241-“Conspiracy against Rights of Citizens—Criminal Action”.  In the case of Poindexter v. Greenhow, 114 U.S. 270, 5 S.Ct. 903 (1885), the U.S. Supreme Court determined that government agents who are acting outside the law or under the color of law and who injure the rights or property are subject to personal liability for their wrongs and are not protected by official immunity:

“The second head of that classification is thus described: 'Another class of cases is where an individual is sued in tort for some act injurious to another in regard to person or property, to which his defense is that he has acted under the orders of the government. In these cases he is not sued as, or because he is, the officer of the government, but as an individual, and the court is not ousted of jurisdiction because he asserts authority as such officer. To make out his defense he must show that his authority was sufficient in law to protect him.' And in illustration of this principle reference was made to Mitchell v. Harmony, 13 How. 115; Bates v. Clark, 95 U.S. 204 ; Meigs v. McClung's Lessee, 9 Cranch, 11; Wilcox v. Jackson, 13 Pet. 498; Brown v. Huger, 21 How. 315; [114 U.S. 270, 288]   Grisar v. McDowell, 6 Wall. 363; and U. S. v Lee, 106 U.S. 196 ; S. C. 1 SUP. CT. REP. 240.”

The law makes it perfectly clear:

26 U.S.C. 3402(n)-1, CFR 31.3402(n)-1—“Not withstanding any other provision of this section, an employer shall not be required to deduct and withhold any tax under this chapter upon a payment of wages to an employee if there is in effect with respect to the payment, a withholding exemption certificate furnished to the employer by the employee which contains statements that—

(a)      The employee incurred no liability for income tax imposed under subtitle A of the Code for his preceding taxable year; and

(b)      The employee anticipates that he will incur no liability for income tax imposed by Subtitle A for his current taxable year.”

No verbal threat or letter from the IRS can abrogate my sworn statement, or the clear intent of the law.  It is not within the authority of the IRS, or my employer, to change or correct a verified affidavit that I signed under penalty of perjury, unless it is proven in a Court of Law that I have perjured myself.  For you to notify my employer to ignore my lawful signed and attested W-4 Form “EXEMPT” and withhold as if I had claimed “0” allowances, when such information is clearly false, without any authority of law and against my consent is unlawful and constitutes EXTORTION UNDER THE COLOR OF OFFICE.  You are also unlawfully interfering with my trade, my right to contract, and my right to retain 100% of the possessory interest in property belonging to me.  If this illegal activity is not stopped immediately, I will file civil and criminal charges personally against you and your agency, and the Department of Justice has no authority to defend you or the IRS under the U.S. Attorney’s Manual section indicated below, so you may have to pay for the defense personally (see :

6-4.270 Criminal Division Responsibility

The Criminal Division has limited responsibility for the prosecution of offenses investigated by the IRS. Those offenses are: excise violations involving liquor tax, narcotics, stamp tax, firearms, wagering, and coin-operated gambling and amusement machines; malfeasance offenses committed by IRS personnel; forcible rescue of seized property; corrupt or forcible interference with an officer or employee acting under the internal revenue laws (but not omnibus clause); and unauthorized mutilation, removal or misuse of stamps. See 28 C.F.R. Sec. 0.70.

However, the DOJ may prosecute your for such violations, and I will bring said violations to the attention of the attorney general, John Ashcroft, promptly, absent you addressing my concerns.

I shall now define what I mean by EXTORTION UNDER THE COLOR OF OFFICE:

EXTORTION UNDER THE COLOR OF OFFICE:  (Black’s Law Dictionary, Revise 4th Edition) “…Unlawful taking by any officer by color of his office, of any money or thing of value, that is not due to him, or more than is due or before it is due.  4 Bla.Comm., 141; Com. V. Saulsbury, 152 Pa. 554, 25 A. 610, U.S. v. Denver, D.C.N.C. 14 F. 595; Bush v. State, 19 Ariz. 195, 168 P.508, 5098…Obtaining property from another, induced by wrongful use of force or fear, or under color of official right.  See State v. Logan, 104 La. 760, 29 So. 336; In re Rempfer, 51 S.D. 393, 216 N.W. 355, 359, 55 A.L.R. 1346; Lee v. State, 16 Ariz. 291, 145 P. 244, 246, Ann.Cas. 1917 B, 131..At common law, any oppression by color or pretense of right, and particularly and technically the exaction or unlawful taking by an officer of money or thing of value, by color of his office, either when none at all is due, or not so much is due, or when it is not yet due.”  Preston v. Bacon, 4 Conn. 480.  See People v. Barondess, 16 N.Y.S. 436, 61 Hun. 571; Murray v. State, 125 Tex.Cr.R. 252, 67 SS.W.2d 274, 275; State v. Anderson, 66 N.D. 522, 267 N.W. 121; 123; Whart.Cr.L. 833.

COLOR OF OFFICE:  (Black’s Law Dictionary, 4th Edition) “A claim or assumption of right to do an act by virtue of an office, made by a person who is legally destitute of such right.”  Feller v. Gates, 40 Or. 543, 67 P. 416, 56 L.R.S. 630, 91 Am.St.Rep. 492.

COLOR:  (Black’s Law Dictionary, 6th Edition) “Pretense of official right to do an act made by one who has no such right.  An act under color of office is an act of any officer who claims authority to do the act by reason of his own office when the office does not confer on him any such authority.

Also, because you and your Chief Examiner, are acting in collusion, outside of your lawfully delegated authority, criminal and civil actions may be brought against you both, in your individual capacity, for “Extortion under the Color of Office.”  It is not necessary to prove that you personally benefited from the money extorted to sustain a conviction or judgment.

I stand by the claims of my original W-4 form and Affidavit of References (1) and (2) but have also resubmitted a W-4 EXEMPT as you requested.  My original form W-4, to the best of my knowledge and belief, is still true as stated and signed and the obligation belongs to you to disprove this, which you have not so far done and are demanded to do.

“The legal right of a taxpayer to decrease the amount of what otherwise would be his taxes or to altogether avoid them, by means which the law permits, cannot be doubted.”  Gregory v. Helvering, 293 U.S. 465.


(1)     Specifically, what statute, implementing regulation and delegation order provides the authority for your claim that there is a MANDATORY “withholding” requirement applicable to me, a Citizen of one of the union American states, domiciled and engaged in an occupation of “common right” (Simms v. Ahrens, 271 SW 720), therein.  Said occupation is NOT classified as the conduct of a trade or business in the “United States” as defined in 26 U.S.C. Section 871 and the implementing regulations.

(2)     Specifically, what statute of the Internal Revenue Code, and related CFR employment regulations, gives you or the Internal Revenue Service, the authority to change my Form W-4, or Affidavit of Exemption, which I have signed under penalty of perjury, and thereby violate my Fifth Amendment right to not be deprived of my property without due process of law or my consent?

(3)     Specifically, what statute or related CFR employment regulation, that is consistent with the Fifth Amendment of the Constitution, provides you with the authority to tell my employer not to accept my W-4 Form unless I claim zero withholding allowances?

(4)     Please immediately provide me with a copy of the specific statutes and regulations upon which you relied to make the determination that my W-4 Form is not accurate for the purposes of claiming an Exemption from withholding.  Also, please explain exactly what I must do to rectify these alleged inaccuracies, as well as copies of any necessary forms which I must file.

This correspondence constitutes a demand that you notify my employer to honor my lawful signed and attested FORM W-4 with my appropriate EXEMPT status, within 10 days from the date of receipt of this letter and notify me that such action has been taken, at the address indicated above.


As you are aware, pursuant to 44 U.S.C.A. 1504-1507, before a citizen of the several States of the United States can be bound by, or adversely effected by a law or regulation, having general applicability to such Citizens, it must be published in the Federal Register.  Such laws and regulations are then categorized pursuant to their applicable Title in the Code of Federal Regulations (CFR).  26 U.S.C. 7805(a) states:

“…the Secretary shall prescribe all needful rules and regulations for the enforcement of this title.”

The Internal Revenue Code is not self-executing.  Without an implementing regulation, applicable to a particular type of tax, a statute has no force of law, and imposes no duties or penalties.  The Parallel Table Authorities for 26 CFR reveals that the Bureau of Alcohol, Tobacco, and Firearms is the only authority authorized to use distraint or assess penalties for nonpayment of income taxes for Title 27 (and NOT Title 26) issues ONLY.  The following is taken from the Parallel Table of Authorities in the back of the Title 26 Code of Federal Regulations [CFR].  It is a list of the ONLY 26 CFR Part 301 Regulations that derive their Authority for implementation from Title 26 USCS or 26 IRC [Income Taxes].  Note the conspicuous absence of any penalty, interest, levy or seizure for the Title 26 Voluntary Income Tax or for filing of allegedly false W-4 forms.  Again, it is inconceivable that the Congress would legislate penalties for the individual income tax, since the supreme Court and the IRS have both substantiated that such a Tax is voluntary and NOT based upon distraint.  It would be absurd to impose penalties for non-compliance, when such an option is what made the tax voluntary to begin with.

Table 1:  Parallel Table of Authorities 26 CFR to 26 USCS


IRS Regulations

Internal Revenue Code

26 Part 301

26 6011

26 Part 301

31 3720A

26 Part 301

26 6245

26 Part 301

26 7805

26 Part 301

26 6233

26 Part 301

26 6326

26 Part 301

26 6404

26 Part 301

26 6324A-6324B

26 Part 301

26 6241

26 Part 301

26 6111-6112

26 Part 301

26 6223

26 Part 301

26 6227

26 Part 301

26 6230-6231

26 Part 301

26 6033

26 Part 301

26 6036

26 Part 301

26 6050M

26 Part 301

26 6059

26 Part 301

26 2032A

26 Part 301

26 7624

26 Part 301

26 3401

26 Part 301

26 6103-6104

26 Part 301

26 1441

26 Part 301

26 7216

26 Part 301

26 6621

26 Part 301

26 367

26 Part 301

26 6867

26 Part 301

26 6689

You can look at the Parallel Table of Authorities yourself at:

In addition, the following court ruling clearly expresses your lack of authority to assess penalties:

“…the Act’s civil and criminal penalties attach only upon the violation of a regulation promulgated by the Secretary; if the Secretary were to do nothing, the Act itself would impose no penalties on anyone…only those who violate the regulations (not the Code) may incur civil or criminal penalties, it is the actual regulation issued by the Secretary of the Treasury and not the broad authorizing language of the statue, which is to be tested against the standards of the 4th Amendment.”  Calif. Bankers Assoc. v. Shultz, 416 U.S. 25, 44, 39 Led2d 812, 94 S.Ct. 1494

Your own Internal Revenue manual, which is reflective of the ruling case law on this subject states that you have no delegated authority to issue a civil penalty or to collect penalties without a judgment signed by a magistrate:

IRM 546 19(b)(2) “the civil penalty for non-compliance may be imposed only by filing a suit in the name of the United States, naming the taxpayer as a defendant and securing a judgment.”

The question then is, where is the fictitious lawsuit that authorizes you to collect a penalty?  The supreme Court agrees with this conclusion in the following case:

“Our system of taxation is based upon voluntary assessment and payment, not upon distraint.” Flora v. U.S. 362 U.S. 145, 1959.

[Emphasis added]

In case you don’t understand, “distraint” is defined as follows and is the equivalent of “force” or “coercion” or “compulsion” in the collection of debts and legal liabilities:

“…the act or process of DISTRAINT whereby a person (the DISTRAINOR), without prior court approval, seizes the personal property of another located upon the distrainor’s land in satisfaction of a claim, as a pledge for performance of a duty, or in reparation of an injury.  Where goods are seized in satisfaction of a claim, the distrainor can hold the goods until the claim is paid and, failing payment, may sell them in satisfaction.”  [Barron’s Law Dictionary, Steven H. Gifis, 1996, p. 150, ISBN 0-8120-3096-6]

Your assessment of penalties and demand for money, without the authority of law, your lawless actions to penalize me that have not been legally defended or explained or justified based on your delegated authority, constitutes extortion under the color of law, mail fraud and conspiracy against the rights of a Citizen, for which you will be help personally liable should legal action become necessary.


Pursuant to 26 U.S.C. Section 6331(a):

United States Code


Subtitle F - Procedure and Administration


Subchapter D - Seizure of Property for Collection of Taxes


 (a) Authority of Secretary

If any person liable to pay any tax neglects or refuses to pay the same within 10 days after notice and demand, it shall be lawful for the Secretary to collect such tax (and such further sum as shall be sufficient to cover the expenses of the levy) by levy upon all property and rights to property (except such property as is exempt under section 6334) belonging to such person or on which there is a lien provided in this chapter for the payment of such tax. Levy may be made upon the accrued salary or wages of any officer, employee, or elected official, of the United States, the District of Columbia, or any agency or instrumentality of the United States or the District of Columbia, by serving a notice of levy on the employer (as defined in section 3401(d)) of such officer, employee, or elected official. If the Secretary makes a finding that the collection of such tax is in jeopardy, notice and demand for immediate payment of such tax may be made by the Secretary and, upon failure or refusal to pay such tax, collection thereof by levy shall be lawful without regard to the 10-day period provided in this section.

I am not an “employee” as such “term” is defined below:

26 U.S.C. 3401(c ) EMPLOYEE—“For purposes of this chapter, the term employee includes [only] an officer, employee or elected official of the United States, a State or any political subdivision thereof, of the District of Columbia, or any agency or instrumentality of any one or more of the foregoing.  The term also includes an officer of a corporation.”

26 CFR 31.3401(c ) Employee: "...the term [employee] includes officers and employees, whether elected or appointed, of the United States, a [federal] State, Territory, Puerto Rico or any political subdivision, thereof, or the District of Columbia, or any agency or instrumentality of any one or more of the foregoing.  The term 'employee' also includes an officer of a corporation."

This correspondence shall constitute constructive notice that I do NOT meet the definition of a person on whom you are authorized to institute distraint of the type above based on the definition of “employee” above, and you are forewarned that you will be held personally liable under 26 U.S.C. 7214(a) for unlawful use of your authority if you violate the above restrictions on your legal authority.  I have also warned my financial institutions and county recorder and employer that a illegal fraud illegal taking of property may be perpetrated by you in the future against my property rights and to bring that to my attention promptly and disregard it.  Your jurisdiction to levy or use distraint is challenged and must be proven by you.

"Whatever the form in which the Government functions, anyone entering into an arrangement with the Government takes the risk of having accurately ascertained that he who purports to act for the Government stays within the bounds of his authority...and this is so even though as here the agent himself may have been unaware of the limitations upon his authority."

Federal Crop Insurance v. Merrill, 332 U.S. 380, 384 (1947)


I, Christopher M. Hansen , Citizen of California and domiciled in San Diego County, California, one of the American union States, hereby extinguish, rescind, revoke, cancel, abrogate, annul, nullify, discharge, and make void ab initio all signatures, belonging to me, on all previously filed Internal Revenue Service, W-4 Forms (other than EXEMPT W-4’s), 1040 Forms (that are not part of Ref. (1)) and all State Income Tax Forms and all powers of attorneys, real and implied, connected thereto, on the grounds that my purported consent was not voluntarily and freely obtained, but was made through mistake, duress, fraud, and undue influence exercised by your agency and my employer.  Pursuant to Contract Law: “All 1040 (not part of Ref. (1)) and W-4 Forms (other than EXEMPT W-4’s) are, hereby, extinguished by this rescission.”.

Rescission: (Black’s 6th Edition Law Dictionary) “To abrogate, annul, avoid, or cancel a contract; particularly, nullifying a contract by the act of a party.  The right of rescission is the right to cancel (rescind) a contract upon the occurrence of certain kinds of default by the contracting party.  To declare a contract void in its inception and to put an end to it as though it never were.  Russel v. Stephens, 191 Wash. 314, 71 P.2d 3031…A rescission amounts to the unmaking of a contract, or an undoing of it from the beginning.  It necessarily involves a repudiation of the contract and a refusal of the moving party to be bound by it…”

I was induced by fraud and duress to sign such forms and I was denied full disclosure of the voluntary nature of such forms.  I was mislead by those who knew, or should have known, into believing that filing such forms was mandatory and/or implied, were inconscionable and grossly unfair to me.  I was unduly influenced by the stronger bargaining power of my employer, the Internal Revenue Service and the State Tax agency, and acted under an implied threat and fear of losing my job and my property and out of fear of potential imprisonment for non-compliance.  Any alleged consent is null and void as it was given under duress, by mistake, and by fraud.  Notwithstanding any information which you may have to the contrary, any forms that have been filed, and any implied quasi contracts that you may feel you have with me, were filed illegally and unlawfully and are without force/and or effect.

I further revoke, rescind, and make void ab initio all powers of attorney pertaining to me for any and all governmental/quasi/colorable agencies and/or Departments created under the authority of Art. I, Sec. 8, Cl. 17, and/or Art. IV, Sec. 3, Cl. 2 of the Constitution of the United States.

I, hereby, voluntarily relinquish any presumptive 14th Amendment citizenship status and any privileges and immunities granted therein.  I retain my natural born status of a Citizen of one of the several union States of America under the Constitution and law, and my Citizenship in these United States of America.  I preserve all my unalienable Rights that are inherent from my Creator, at all times.  I waive no rights at any time.  I do not, at any time, designate anyone to be a binding arbitrator in any disputes of my Rights or equity.  If your agency has a Constitutionally valid claim, you must adhere to Due Process of Law, and other protections according to the Constitution, and I will remain an Involuntary Litigant in any such action.


I will pursue the following if you do not comply with the requests in this correspondence in a timely fashion and as required by your responsibilities and delegated authority:

1)       Filing of IRS form 911, which requests help from the Taxpayer Advocate’s office.

2)       Writing letters to my senators and congressmen.

3)       Adjudicatory/examination hearing.

4)       Filing a Referral and Request for “Technical Advice” under 26 CFR 601.105(b)(5)(iii) and IRM, [4.2] 7.2.10.

5)       Posting all of your correspondence and my responses on the website located at in order that other concerned citizens may learn from and reuse the litigation tools developed dealing with you.

6)       Prosecuting and holding you personally liable under the following Statutes:

a.       26 U.S.C. Sec. 7214

b.       42 U.S.C. 1983-Civil Action for Deprivation of Rights

c.       18 U.S.C. 241-Conspiracy against Rights of Citizens—Criminal Action

d.       26 U.S.C. 7433-Civil Damages for Certain Unauthorized Collection Actions

You are forewarned that all future interactions with you via telephone will be recorded and posted for public listening on the website at, and that any attempts to contact me either by phone or in person shall constitute due consent by you to be electronically recorded.  These recordings will be used as evidence in the process of litigating my Civil and Criminal Action for Abatement of Penalties and Conspiracy against rights.

Should you wish to further investigate the claims contained in this letter or the research to back it up, you are encouraged to visit the website at and download the free book called The Great IRS Hoax: Why We Don’t Owe Income Tax.  The book is free and very completely reveals and exposes the fraud of the income tax that most sovereign American Nationals have been repeatedly and maliciously victimized by through ignorance and illegal activities of employees at your agency.

You are requested to promptly bring to my attention and rebut, point-by-point, any errors in fact or law revealed in this correspondence.  Absent any rebuttal, you will be served with a Verified Affidavit of Default documenting all established facts contained in this and in previous correspondences of Refs. (1) and (2), and which will be used against you in my pending litigation to have you prosecuted for malfeasance and EXTORTION UNDER THE COLOR OF OFFICE.

Finally, I wish to emphasize that the best interests of the taxpaying public, your agency, and the United States Government are not served by your frivolous, negligent, libelous, and unethical misapplication of the tax laws in my case.   Your ignorant misapplication of the laws will ultimately result in extended litigation that will negate any benefit you might gain by attempting to collect taxes or penalties, not to mention jeopardize your job and the credibility of your agency.  Furthermore, everything I learn in the process of fighting you will be recycled and posted on the internet at for many hundreds of thousands of other tax freedom fighters to reuse in the process of litigating against your clearly unethical and lawless disregard for my lawful, Constitutional, and property rights.

“When the government fears the people, you have liberty.  When the people fear the government [or the IRS, for that matter], you have tyranny.”

(Thomas Jefferson, author of the Declaration of Independence)

“Better is a little with righteousness.

Than  vast revenues without justice.”

(Bible, Prov. 16:8-9)

I thank you kindly for taking the time to diligently read and respond to this correspondence and to References (1) and (2), and for acting in an ethical, respectful, and responsible way that honors the legal constraints imposed upon your position as a revenue officer acting under the color and authority of the laws of the United States government.  It is only by you observing the legal limitations imposed on your position that the IRS and the U.S. Government can ever hope to earn and keep the public trust and confidence that all Citizens living in the 50 states would like to have in your agency and in their government.

May God richly bless you and yours with a clear conscience and the blessings of liberty and freedom that we all long for in this wonderful nation of ours.

If you wish to contact me about this correspondence, you may call me during normal working hours at ___________ or by email at _______________.  It is my intention to telephone you about this correspondence within a few days.

Under the penalties of perjury, I declare that I examined the facts stated in this protest including any accompanying documents, and, to the best of my knowledge and belief, they are true, correct, and complete.

Very Respectfully,




All Rights Reserved Without Prejudice, UCC 1-207

Former SSN (no longer active)______________




STATE OF _____________   )

COUNTY OF ____________  )


On __________________________ before me ___________________personally appeared ______________________ personally known to me (proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument, and acknowledged to me that he executed same in his authorized capacity, and that by his signature on the instrument the person or the entity upon behalf of which the person acted, executed the instrument. 

I do hereby certify that I have served _______________________________________________(name of agency or person served) with a true copy of the within document (circle one) (personally)/(by Certified Mail with Return Receipt Requested), from/at _______________________________________________________________ (city and state mail was sent from).


Witness my hand and official seal.




Signature of Notary:_______________________________________

 Certified Mail #:______________________________________ 

 Cc:  Internal Revenue Service

       Congressmen and Senator