:C.-S.-S.-C.-P. -S.-G.

-FLAG OF THIS VESSEL

FOR THE CLAIMANT'S-KNOWLEDGE OF THIS LIVE-LIFE IS WITH THIS CLAIM BY

THIS CLAIMANT.
~1 FOR THIS CLAIMANT'S-KNOWLEDGE OF THIS LIVE-LIFE IS WITH THIS CLAIM
OF THE LIVE-BIRTH-NAME: __________________________________________________,
ON THIS DATE-~______ DAY WITHIN THE MONTH-~_____________ , IN THE YEAR-~
_______ BY THESE WITNESSES AND: CLAIMANT.
~2 FOR THESE WITNESSES-KNOWLEDGE OF THIS LIVE-LIFE-BIRTH IS WITH THE
LOCATION IN THE CITY-~ _______________________ TERRITORY-___________________
BY THE PARENTS: FATHER:________________________________,
MOTHER:__________________________________.
~3 FOR THESE WITNESSES OF THIS LIVE-LIFE-BIRTH ARE, ON THIS DATE-~______
DAY WITHIN THE MONTH-~____________ , IN THE YEAR-~ ______ WITH THE CLAIM
OF THE CLAIM OF THIS LIVE-LIFE-DOCUMENT:_______________________________,
:_____________________________________, :______________________________________.

~4 FOR THIS PICTURE, FINGERPRINT-SEAL AND: DNA-SAMPLE OF THIS

CLAIMANT ARE WITH THESE CLAIMS OF THIS FACTUAL-LIVE-LIFE-BIRTH:

:PICTURE: :FINGERPRINT: :DNA-BLOOD/SALIVA:

:____________________________________. :____________________________________.
:AUTOGRAPH-WITNESS- :AUTOGRAPH-WITNESS-
COPYRIGHT/COPYCLAIM. COPYRIGHT/COPYCLAIM.

:________________________________________________.
:AUTOGRAPH-CLAIMANT-LIFEBIRTH-
COPYRIGHT/COPYCLAIM.

FOR THIS COPYRIGHT/COPYCLAIM~2~FEBRUARY-~2000 BY THIS PLENIPOTENTIARY-

JUDGE: David-wynn: Miller. WITH THE CONTRACY-STATES-CORPORATION OF THIS LIFE-
BIRTH-CLAIMANT.