Certificate of Ownership,

Title, Underwriting & Authority

Over the Social Security Account
JOHN IAM FREEMAN
The undersigned, John Iam Freeman, does solemnly swear as proof of authority and
ownership over the Social Security account 123456789, declare and state as follows:

I am competent to state the matters set forth herein.

My file name on the State of Pennsylvania Birth Certificate is JOHN IAM FREEMAN.
My Social Security Number is 123-45-6789 and my card is pictured below (Figure-1).
My United States of America Passport number is 987654321, expires 01 January 2027.
All the facts herein are true, correct and complete, admissible as evidence and if called
upon as a witness, John Iam Freeman will testify to their veracity.
Figure-1

_______________________________________
Original Trustee, John Iam Freeman

NOTARY PUBLIC
Sworn to (or affirmed) and subscribed before me on this day
by John Iam Freeman, proved to me on the basis of satisfactory evidence to be the one who
appeared before me, and executed the forgoing instrument for the purpose stated therein and
Figure-1
acknowledged that said execution was by his free act and deed.

[Notary Seal:]

Notary's Signature:

Printed Name: My commission expires:

Reference: FT-DODD-IAM-JIF-04JULY1776