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The next letter is intended to be attached to any government form in which:

1.        A Social Security Number is demanded.

2.        You don’t want to have or use a Social Security Number (SSN) and you feel that it violates your rights.

3.        You are told that the form or application cannot be processed without the number.

We first used this form as an addendum to a U.S. military ID application, in which an SSN was demanded, but it has been made generic so that it is useful in many different circumstances and with many different types of forms.  To use this form, simply write above the signature on the government form you are signing the following:

“Not valid and not consensual without the signed attachment, 2 pages.”

You might want to take along a witness with you when you try to submit the government form that accompanies this attachment, so that the witness can sign an affidavit documenting discrimination by the clerk if the clerk refuses to accept your application that contains the attachment or refuses to accept the application absent a Slave Surveillance Number.  That way you will have evidence you can use in court to prove that you were discriminated against and denied a right or benefit based on your failure to use or disclose a Socialist Security Number.  Make sure the affidavit that your witness signs is notarized so that it becomes self-authenticating in court under Federal Rule of Evidence 902.

ATTACHMENT TO APPLICATION FOR: ______________________________
FORM NUMBER: __________________
MY NAME:  ____________________________________
NAME OF GOVERNMENT CLERK PROCESSING APPLICATION:_____________________________________

This attachment forms an inseparable part of the Form_______(form number) enclosed.  The attached form is invalid and submitted absent my consent without this attachment.

I, ___________________________________(your name), wish to solemnly and plainly declare the following important facts to posterity relating to this transaction with the government:

1.        The attached application requires a Social Security Number.

2.        I neither “have” nor want to obtain a Social Security Number.  The one that is indicated on the form is wrong, should not be relied upon, and should be removed from any and all government records because not doing so violates my wishes and is non-consensual.  In a free country, anything that is not consensual is unjust.  See the Declaration of Independence, which says that all just powers of government derive from the consent of the governed.  This means that anything not consensual is unjust.

3.        The clerk processing the application, informs me that the system she is using will not work without a Social Security Number.  He or she has been afforded no reasonable way to respect my privacy and wishes in this case, which is completely unacceptable and damaging to me personally.

4.        Under 42 U.S.C. 408, it is a felony to compel the use or disclosure of Social Security Numbers. 




Sec. 408. Penalties

(a) In general
Whoever -...

(8) discloses, uses, or compels the disclosure of the social security number of any person in violation of the laws of the United States; 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.

You will note that denying a right or benefit is a form of compulsion, and especially if there is no statute or regulation that authorizes denying a right based on failure to disclose or use a Social Security Number.

5.        It is also a violation of the First Amendment to be required to disclose a Social Security Number.  The First Amendment requires that the federal government may not interfere with my desire to NOT communicate certain information such as identifying numbers.  The Fourteenth Amendment applied the First Amendment to the state governments as well.  Here is what the Supreme Court of the United States said on this subject:

“The right to speak and the right to refrain from speaking are complementary components of the broader concept of ‘individual freedom of mind.’”  Wooley v. Maynard, 430 U.S. 705 (97 S.Ct. 1428, 51 L.Ed.2d 752 (1977)

6.        It is my wish and my belief, as a Christian, that it is my duty to completely separate my relationship with the government from my private life, but the the government is making that impossible in this case by forcing me to disclose information about my private life that has nothing to do with my work performance, and which has a great possibility that it will be used to incriminate me in a number of subtle ways that creates fear of God’s (and government’s) wrath and real concern on my part:

"Come out from among them [the unbelievers]
And be separate, says the Lord.
Do not touch what is unclean
And I will receive you.
I will be a Father to you,
And you shall be my sons and daughters,
Says the Lord Almighty."  
[2 Corinthians 6:17-18, Bible, NKJV]

"Do not love the world or the things in the world.  If anyone loves [is a citizen of] the world, the love of the Father is not in Him.  For all that is in the world--the lust of the flesh, the lust of the eyes, and the pride of life--is not of the Father but is of the world.  And the world is passing away, and the lust of it; but he who does the will of God abides forever."  [1 John 2:15-17, Bible, NKJV]

"Adulterers and adulteresses!  Do you now know that friendship [and "citizenship"] with the world is enmity with God?  Whoever therefore wants to be a friend [citizen] of the world makes himself an enemy of God."  [James 4:4, Bible, NKJV]

"Pure and undefiled religion before God and the Father is this: to visit orphans and widows in their trouble, and to keep oneself unspotted from the world [and the corrupted governments and laws of the world]." [James 1:27, Bible, NKJV]

"And you shall be holy to Me, for I the Lord am holy, and have separated you from the peoples, that you should be Mine."  [Leviticus 20:26, Bible, NKJV]

"And I heard another voice from heaven saying, 'Come out of her [Babylon the Great Harlot], my people, lest you share in her sins, and lest you receive of her plagues.'"  [Revelation 18:4, Bible, NKJV]

"I am a stranger in the earth;
Do not hide Your commandments from me."
Psalms 119:19, Bible, NKJV]

I have become a stranger to my brothers,
And an alien to my mother's children;
Because zeal for Your house has eaten me up,
And the reproaches of those who reproach You have fallen on me.”
Psalms 69:8-9, Bible, NKJV]

7.        It is also a violation of my religious beliefs as a Christian to use or obtain SSNs.  The book of Revelations, Chapters 17 and 18 in the Bible, calls them “the mark of the Beast” (see Rev. 13:16-18, Bible, New King James Version) and it calls “the beast” the political rulers in government (see Revelations 19:19, Bible, New King James Version).  The government has no Constitutional authority to violate my First Amendment rights and religious beliefs and may not turn those rights into privileges as it is attempt to unlawfully do here, by withdrawing a privilege if I do not forfeit a right.

“It would be a palpable incongruity to strike down an act of state legislation which, by words of express divestment, seeks to strip the citizen of rights guaranteed by the federal Constitution, but to uphold an act by which the same result is accomplished under the guise of a surrender of a right in exchange for a valuable privilege which the state threatens otherwise to withhold.  It is not necessary to challenge the proposition that, as a general rule, the state, having power to deny a privilege altogether, may grant it upon such conditions as it sees fit to impose.  But the power of the state in that respect is not unlimited, and one of the limitations is that it may not impose conditions which require the relinquishment of Constitutional rights.  If the state may comp[el the surrender of one constitutional right as a condition of its favor, it may, in like manner, compel a surrender of all.  It is inconceivable that guaranties embedded in the Constitution of the United States may thus be manipulated out or existence.”  [Frost v.  Railroad Commission, 271 U.S. 583; 46 S.Ct. 605 (1926)]

8.        It is also a violation of my Fifth Amendment rights, because the information provided can and probably will be used to incriminate me at one point or another and gives the government all kinds of ways to find out unrelated and personal information about me that I have no desire to disclose under any circumstance for any reason or any amount of money.

9.        Consequently, I am compelled unlawfully and under duress in violation of 42 USC 408 and the First Amendment to obtain and use an SSN in this case.  The clerk, his/her supervisors, and the government agency which employs them are felons and criminals in this case and will be held individually and personally liable for their criminal trespass upon my Constitutional Rights and for perjuring the oath they took as public servants to support and defend the Constitution against all enemies, foreign and domestic.  It is my intention to prosecute the government and/or its agents for this perjury and tort.


10.1.   Notwithstanding any statute, regulation, or internal policy to the contrary, submission of this application DOES NOT constitute consent or permission to enter ANY of the information, and especially the incorrect SSN, into any electronic information system or to share the information with any third party, law enforcement, government, or agency.

10.2.   In fact, I insist under the authority of the Privacy Act, 5 U.S.C. 552a, and the First Amendment, that all identifying numbers, including SSN or TIN, that are related to me are COPYRIGHTED by me and are subject to disclosure ONLY under terms that I designate IN WRITING and IN ADVANCE for each specific instance of disclosure.

10.3.   I insist that all identifying numbers relating to me be erased and completely eliminated and destroyed from the records of the Department of the Navy, the Department of Defense, and the U.S. government in their entirety.  If this is not done, the penalty for violating the copyright shall be one million dollars.  Acceptance of this application constitutes consent and asset to the terms of this license agreement.

10.4.   Government waives its right to use any of the information appearing on this document or the form attached or in the records of the applicant for any of the following purposes, and violation constitutes a copyright violation for which a one million dollar personal liability shall ensue for each occurrence:

10.4.1. Criminal prosecution.  Instead, immunity is hereby granted by the government under 18 U.S.C. 6002.

10.4.2. Disclosure to any taxing organization or agency.

I declare that:

1.        This application was completed outside the “United States” defined in most federal statutes, outside of federal legislative jurisdiction, and outside of federal police powers, from within a state of the union on land not ceded to the federal government.

2.        The information provided, OTHER THAN the incorrect SSN, is true and correct under penalty of perjury in accordance with 28 U.S.C. 1746(1) and only when litigated in a state court with a jury trial, but not in a federal court.

3.        That even if the government asserts that the form or information was prepared or submitted on federal property, Constitutional rights are still affected because of the invasion of privacy of the submitter which occurs during non-working hours.  Use of SSN’s makes it completely impossible to separate one’s work environment from their personal life, because these numbers are also used for many, if not most personal matters as well, such as credit checks, opening bank accounts, and taxes.

Signature of submitter:____________________________________________ Date:_____________________

Recipient or submitting witness siguature: _____________________________ Date:_____________________