Describe Your Complaint tif necessary, attach additional sheets) - Continued

This is a demand that, according to the laws of California and the United States, Mr. Obama's name NOT BE ON THE 2012 BALLOT as a non-natural born Citizen, and also due to his use of in order to obtain and/or maintain

(Primaries or General Election) in California - due to his ineligibility forged and falsified documents, [employme~t i~ ~he representing

a gross act of Mispersonization

of Identity,

u.s, Government.




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Signature - I acknowledge that all of the above information is true and accurately reflects the matter in question, to the best of my knowledge. Signature


I --Yl4f2lt.~

I Date



Return this form to: California Secretary of State Election Fraud Investigation Unit 1500 11th Street, 5th Floor, Sacramento, CA 95814 Fax: (916) 653-3214 For more information or assistance: English: (916) 657-2166 or (800) 345-VOTE (8683) Spanish: (800) 232-VOTA (8682)

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