THE MOORISH NATIONAL REPUBLIC

THE MOORISH DIVINE AND NATIONAL MOVEMENT OF THE WORLD

Aboriginal and Indigenous Natural Peoples of North-West Amexem North America

Affidavit of Fact
(Unlawful Demand of Immunization)

February 22, 2011

For the Record, On the Record, and Let the Record show, I Am <Free National Name>, a Moorish American
National Aboriginal, Indigenous Natural Divine Being manifested in Human Flesh to the Americas, In Propria
Persona, Sui Juris, and not a nom-de-guerre, straw-man or any other artificial corporate construct, as written or
scribed in ALL CAPITAL LETTERS and written by the unclean hands of others. I am Sovereign to this Land and
preserve all my rights.

It is against my religion, as protected by the United States Republic Constitution Article I of the Bill of Rights, to
engage in any way with the immunization process.

In addition, as immunization is a voluntary process I therefore choice not to participate in the process.

Any further discussion or any retaliation regarding my religion as it related to the immunization process will
constitute a violation of my Constitutional / Treaty secured rights.

The sole obligation of government, as stipulated in the United States Republic North American Constitution Article
IV Section IV, as a Republican form of government is to secure, protect, and preserve the rights of the People
domestically and internationally.

MIRANDA v. ARIZONA , 384 U.S. 436 (1966) 491; 86 S. Ct. 1603

"Where rights secured by the Constitution are involved, there can be no 'rule making' or legislation which
would abrogate them."
Norton v. Shelby County, 118 U.S. 425 p. 442
"An unconstitutional act is not law; it confers no rights; it imposes no duties; affords no protection; it
creates no office; it is in legal contemplation, as inoperative as though it had never been passed."
 
Notice to Agent is Notice to Principal – Notice to Principal is Notice to Agent.

    Affiant, <FreeNationalName>, ex-relatione <Strawname>, a living, breathing, flesh-and-blood, natural being
woman, do affirm that Affiant has scribed and read the foregoing facts, and, in accordance with the best of Affiant's
firsthand knowledge and conviction, such are true, correct, complete, and not misleading, the truth, the whole truth,
and nothing but the truth.

In Honor,
I Am: ______________________________
<FreeNationalName>, Authorized Representative
Natural Person, In Propria Persona:
All Rights Reserved: U.C.C. 1-207/1-308; U.C.C.1-103
Quinnehtukqut Territory
[c/o <Mailing Location]
[Near Corporate <City> <State> <[Zipcode]>]
Northwest Amexem

Cc: United Nations United States Justice Department

Geneva Switzerland United States Attorney General Eric H. Holder

State of Connecticut Governor International Criminal Court

Dannel P. Malloy The Hague, The Netherlands

Witness: ____________________________________________
A Free and Sovereign Moorish American National, Northwest Amexem / Africa / America
All Rights Reserved

Witness: _____________________________________________
A Free and Sovereign Moorish American National, Northwest Amexem / Africa / America
All Rights Reserved

Witness: _____________________________________________
A Free and Sovereign Moorish American National, Northwest Amexem / Africa / America
All Rights Reserved