To: Office of Secretary of Treasury

From: [Your Name Address, SSN and Child Support Case Number]

WITHHOLDING OF FUNDS FROM FEDERAL INCOME TAXES

TO SATISFY ALLEGED PAST-DUE SUPPORT OR

ADMINISTRATIVE OFFSET

THE UNDERSIGNED [YOUR NAME] IS A STATE CITIZEN,1 AND

IS NOT DOMICILED WITHIN THE GEOGRAPHICAL LOCATION

OF “State”2 AND THEREBY THE UNDERSIGNED [YOUR NAME]

FEDERAL INCOME TAXES CANNOT BE INTERCEPTED FOR

PAYMENTS OF FEDERAL NON-TAX DEBTS OWED TO THE

“UNITED STATES”3 UNDER “ADMINISTRATIVE OFFSET”4 FOR

1
"One may be a citizen of a State and yet not a citizen of the United States. Thomasson v State, 15 Ind.
449; Cory v Carter, 48 Ind. 327 (17 Am. R. 738); McCarthy v. Froelke, 63 Ind. 507; In Re Wehlitz, 16 Wis.
443."
Mc Donel v State, 90 Ind. Rep. 320 at pg 323;
2
“State” 42 U.S. Code § 1301(a)(1) – Definitions The term “State”, except where otherwise
provided, includes the District of Columbia and the Commonwealth of Puerto Rico, and when used in
subchapters IV, V, VII, XI, XIX, and XXI includes the Virgin Islands and Guam. Such term when used in
subchapters III, IX, and XII also includes the Virgin Islands.
3
28 USC Section 3002(15) (15)“United States” means—(A)a Federal corporation;
(B)an agency, department, commission, board, or other entity of the United States; or
(C)an instrumentality of the United States.
4
31 U.S. Code § 3701 - Definitions and application “administrative offset” means withholding
funds payable by the United States (including funds payable by the United States on behalf of a State
government) to, or held by the United States for, a person to satisfy a claim.

1
THE REASON THE UNDERSIGNED IS NOT UNDER THE

PERSONAL JURISDICTION OF THE OFFICE OF THE

SECRETARY OF STATE OF HEALTH AND HUMAN SERVICES

FOR THE COLLECTION OF PAST-DUE SUPPORT5 UNDER

FEDERAL STATUTE 42 USC SECTION 664 CHAPTER VII

SUBCHAPTER IV

The undersigned is alleged to be a debtor [Type in your name and remove

brackets] for funds owed to the “United States6” and has received notice that

his federal income taxes has been or will be intercepted for unpaid past-due

child support.

The undersigned is requiring that the Office of Secretary of Treasury

withdraw its intentions for intercepting the federal income taxes for alleged

past-due child support also referred to as “Administrative Offset, ”

The undersigned alleged debtor is not under the personal jurisdiction of

federal statutes 42 USC Sections 651-669(b) and wishes for the Office of

Secretary of Treasury to acknowledge this fact and comply with the federal

statutes that consistently defines the geographical location of the term

5
42 USC § 664(c) “In this part the term “past-due support” means the amount of a delinquency,
determined under a court order, or an order of an administrative process established under State law,
for support and maintenance of a child (whether or not a minor), or of a child (whether or not a minor)
and the parent with whom the child is living”
6
28 USC Section 3002(15) “United States” means—(A)a Federal corporation;
(B)an agency, department, commission, board, or other entity of the United States; or
(C)an instrumentality of the United States.

2
“State”7(Please refer to footnote # 5) and it is a fact that the undersigned

alleged debtor is not domiciled within this geographical location and the

State child support collection agency is not located within the geographical

location of the term “State” and therefore is without personal jurisdiction

over the undersigned alleged debtor and therefore his federal income taxes

must not be intercepted unless proof of consent to repayment by installment

payments for a loan can be substantiated.

THE UNDERSIGNED [YOUR NAME] IS A STATE CITIZEN,8

WITHOUT THE EVIDENCE OF A DEBT AGREEMENT IS

ALLEGED BY A TITLE IV-D TO BE A DEBTOR FOR UNPAID

PAST-DUE CHILD SUPPORT AND CLAIMS THAT HE IS NOT

DOMICILED WITHIN THE “State”9 FEDERAL STATUTES 42 USC

SECTIONS 651-669(b) AND THE OFFICE OF SECRETARY OF

7
“State” 42 U.S. Code § 1301(a)(1) – Definitions The term “State”, except where otherwise
provided, includes the District of Columbia and the Commonwealth of Puerto Rico, and when used in
subchapters IV, V, VII, XI, XIX, and XXI includes the Virgin Islands and Guam. Such term when used in
subchapters III, IX, and XII also includes the Virgin Islands.
42 USC SECTION 652 DUTIES OF SECRETARY (a) Establishment of separate organizational unit;
duties The Secretary shall establish, within the Department of Health and Human Services a separate
organizational unit, under the direction of a designee of the Secretary, who shall report directly to the
Secretary and who shall—
8
"One may be a citizen of a State and yet not a citizen of the United States. Thomasson v State, 15 Ind.
449; Cory v Carter, 48 Ind. 327 (17 Am. R. 738); McCarthy v. Froelke, 63 Ind. 507; In Re Wehlitz, 16 Wis.
443."
Mc Donel v State, 90 Ind. Rep. 320 at pg 323;
9
“State” 42 U.S. Code § 1301(a)(1) – Definitions The term “State”, except where otherwise
provided, includes the District of Columbia and the Commonwealth of Puerto Rico, and when
used in subchapters IV, V, VII, XI, XIX, and XXI includes the Virgin Islands and Guam. Such term
when used in subchapters III, IX, and XII also includes the Virgin Islands.

3
HEALTH AND HUMAN SERVICES10 IS WITHOUT PERSONAL

JURISDICTION OVER THE ALLEGED DEBTOR AND WITHOUT

PERSONAL JURISDICTION AND IS CLAIMING NON-

ASSUMPSIT11 AND DEMANDING PROOF OF AN UNDERTAKING

FOR CONSENT TO REPAY A LOAN FOR SUPPORT BY

INSTALLMENT PAYMENTS THROUGH A STATE CHILD

SUPPORT SEPARATE UNIT ESTABLISHED UNDER 42 USC

SECTION 654(3) IS REQUIRED

The 42 U.S. Code § 664 - Collection of past-due support from Federal tax

refunds is without personal jurisdiction over the body of [type in your name

and remove brackets] and thereby without a federal statute to enforce the

interception of alleged past-due support requires knowing consent by the

undersigned alleged debtor for past-due support.

The undersigned does not recall agreeing to terms for installment repayment

of a loan and thereby without proof of any written contract, the undersigned

alleged debtor is hereinafter a man without debts to the United States and

10
42 USC SECTION 652 DUTIES OF SECRETARY (a) Establishment of separate organizational unit;
duties The Secretary shall establish, within the Department of Health and Human Services a
separate organizational unit, under the direction of a designee of the Secretary, who shall
report directly to the Secretary and who shall—
(1) establish such standards for State programs for locating noncustodial parents, establishing
paternity, and obtaining child support and support for the spouse (or former spouse) with whom
the noncustodial parent’s child is living as he determines to be necessary to assure that such
programs will be effective;
11
NON-ASSUMPSIT- “The general issue in the action of assumpsit; being a plea by which the defendant
avers that “he did not undertake” or promise as alleged.” The Law Dictionary
Featuring Black's Law Dictionary Free Online Legal Dictionary 2nd Ed.

4
must be freed from any further communications for repayment of debts by

any income withholding or interception of federal income taxes.

The undersigned alleged debtor is demanding proof of an undertaking for the

repayment of a loan as defined by 42 USC section 666(5)(H) for the

definition of default.12

The undersigned [type in your name and remove brackets] is requiring the

Office of the Treasury to withdraw from intercepting federal income taxes

and comply with fact the undersigned is not under the personal jurisdiction

of the Office of Secretary as defined by terms under federal statutes 42 USC

Sections 651-669(b) for the establishment and enforcement of payment for

state child support through state child support agencies or contractors13

12
Default- defined by 42 USC SECTION 666(5)(H) “default ” (A)the term “default” means the failure
of a borrower of a loan made under this part to— (i)make an installment payment when due; or
(ii)comply with any other term of the promissory note for such loan,
13
The Supreme Court in Matter Blessing v. Freestone, 520 US 329 - Supreme Court 1997
stated “To qualify for federal AFDC funds, the State must certify that it will operate a child support
enforcement program that conforms with the numerous requirements set forth in Title IV—D of the
Social Security Act, 42 U. S. C. §§ 651-669b”

5
____________________________
Please sign your name in front of a Notary Public