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[Change all items in blue below, delete red notes, then change all print to black before

1 printing.]DECLARATION OF DARREN T. CARLSON


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IN THE MUNICIPAL COURT OF THE STATE OF CALIFORNIA
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FOR THE COUNTY OF ORANGE
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STATE OF CALIFORNIA, Case No. 0108-XXXX
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Plaintiff, AFFIDAVIT OF ORIGINAL ISSUE;
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v. NOTICE OF ALLEGED
9 DEFENDANT'S ACCEPTANCE OF
JOHN H. DOE©, CLAIM;
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Alleged Defendant. NOTICE OF COURT'S
11 ABANDONMENT OF CLAIM;
12 MOTION AND ORDER TO DISMISS
13 [Change all to the particulars of your case,
14 i.e., the plaintiff, defendant, and your
15 document name, case number, etc.]
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17 State of CALIFORNIA )
) ss.
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County of ORANGE )
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20 SWORN AFFIDAVIT OF FACT


21 I, John Henry, family of Doe, the Undersigned Affiant, hereinafter "Affiant," does hereby
22 solemnly swear (or affirm), declare, and state as follows:
23 1. Affiant is competent to state the matters set forth herewith.
24 2. Affiant has personal first-hand knowledge of the facts stated herein.
25 3. All the facts stated herein are true, correct, and complete in accordance with Affiant's
26 best firsthand knowledge and understanding, and if called upon to testify as a witness

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1 Affiant shall so state.

3 Plain Statement of Facts

4 4. Affiant is the agent for alleged Defendant JOHN H. DOE©.

5 5. Alleged Defendant JOHN H. DOE© is the "Original Issuer" of the credit on the debt

6 instrument commonly known and identified as Claim or Case No. 0108-XXXX in

7 THE MUNICIPAL COURT OF THE STATE OF CALIFORNIA FOR THE

8 COUNTY OF ORANGE.

10 6. THE MUNICIPAL COURT OF THE STATE OF CALIFORNIA FOR THE

11 COUNTY OF ORANGE is a corporation doing business under an unknown tax

12 identification number also known as THE EAST OCEANSIDE MUNICIPAL

13 COURT OF THE STATE OF CALIFORNIA located at 1234 River Avenue,

14 OCEANSIDE, CA 86851.

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16 7. The Original Issue price of $20,289.92 for Claim or Case No. 0108-XXXX was

17 accepted on June 30, 2008, by THE MUNICIPAL COURT OF THE STATE OF

18 CALIFORNIA FOR THE COUNTY OF ORANGE and is filed on Internal Revenue

19 Service Form 1099-OID (attached hereto and stated herein as alleged Defendant's

20 "Exhibit A").

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22 8. Creditor JOHN H. DOE© accepted the Claim or Case No. 0108-XXXX on the

23 attached Internal Revenue Service Form 1099-OID (please see "Exhibit A") for the

24 assessed value of the taxes owed.

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26 9. There being no controversy in THE EAST OCEANSIDE MUNICIPAL COURT OF

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1 THE STATE OF CALIFORNIA on Claim or Case No. 0108-XXXX, this court does

2 not have subject matter jurisdiction and must vacate any order(s) or judgment(s)

3 made.

5 10. THE EAST OCEANSIDE MUNICIPAL COURT FOR THE STATE OF

6 CALIFORNIA has abandoned the claim (attached hereto and stated herein as alleged

7 Defendants "Exhibit B").

9 11. THE EAST OCEANSIDE MUNICIPAL COURT FOR THE STATE OF

10 CALIFORNIA is in receipt of the proper Internal Revenue Service Forms 1099-OID

11 and 1099-A (attached hereto and stated herein as alleged Defendant's "Exhibits A &

12 B") for the abandonment of the Tax in this Claim or Case No. 0108-XXXX.

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14 12. THE EAST OCEANSIDE MUNICIPAL COURT FOR THE STATE OF

15 CALIFORNIA, a corporation doing business under an unknown tax identification

16 number located at 1234 River Avenue, OCEANSIDE, CA 86851, is in violation of

17 United States Code Title 26 for Tax Fraud.

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19 Wherefore the undersigned hereby moves the Court to dismiss the Plaintiff’s

20 complaint of June 30, 2008. The undersigned is not a lawyer.

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22 Dated this ______ day of _________________, 2008.

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24 JOHN H. DOE©, alleged Defendant

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26 By: John Henry, Agent


John Henry, family of Doe, a living being
Principal, Sovereign, Power of Attorney-in-Fact
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No liability assumed
1 Always with all God-given rights, waiving none ever

3 JURAT
4 County of ORANGE )
) ss.
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State of CALIFORNIA )
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7 Signed and sworn to (or affirmed) before me on this, the ______ day of June, A.D. 2008,

8 by John Henry, family of Doe. WITNESS my hand and official seal:

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___________________________________________
10 Notary for the State of CALIFORNIA
My commission expires: ____________________
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14 ORDER

15 IT IS HEREBY ORDERED that the above captioned case, and the Complaint of the
16 Plaintiff be dismissed with prejudice and any Notice(s) of Lis Pendens be removed from record.
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18 Dated: _____________________, 2008.

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21 __________________________________________
Presiding Judge
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