Record of Parentage

and Statement of Non-Corporate Status

This certifies that __Jane-Mary______ of the ____Doe__ family was born a single
Given Name Surname
living female, flesh & blood soul, on the day ________________________at __________
Date Born Hour
in the several _____________State in ______________, ______________
Country County City
to parents: _________________ of the ___________________ family
Mother
and ____________________of the ________________ family

Father
I, the attesting witness, declare under penalty of perjury WITHOUT the UNITED
STATES, that the above stated facts are the truth, the whole truth, and nothing but the
truth to the best of my knowledge, information, belief, and overstanding.

_____________________________________________________________________
_
Attesting Witness (Mother) Autograph Seal Date

_____________________________________________________________________
_
Attesting Witness (Cousin) Autograph Seal Date

_____________________________________________________________________
_
Attesting Witness (Cousin) Autograph Seal Date

_____________________________________________________________________
_

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 Record of Parentage
and Statement of Non-Corporate Status

Attesting Witness (Cousin) Autograph Seal Date

Let it be known to all that I, Jane-Mary: Doe, a sentient being, a living woman over the
age of 18, reserve my natural common law right not to be compelled to perform under
any contract of adhesion that I did not enter into knowingly, voluntarily, and intentionally.
And furthermore, I do not accept the liability associated with the compelled and
pretended "benefit" of any hidden or unrevealed contract or commercial agreement, and
specifically I refuse to be included in any federal zone.

I swear under penalty of perjury WITHOUT the UNITED STATES that I am one of the
People of these united states of America, being a creation of God, born and domiciled in
one of the several States, and the information I have provided is true and accurate to
the best of my knowledge, information, and belief. I hereby affix my own autograph to
this entire document with explicit reservation of all my unalienable rights and my specific
common law right not to be bound by any contract or obligation which I have not
entered into knowingly, willingly, voluntarily, and without misrepresentation, duress, or
coercion.

THE USE OF THE NOTARY BELOW IS FOR IDENTIFICATION AND WITNESS OF

AUTOGRAPH AND SEAL, AND SUCH USE DOES NOT GRANT ANY JURISDICTION
TO ANYONE.

This document was created, autographed, and sealed by: Jane-Mary: Doe, a woman
over the age of 18, a Living Soul on the ______day of _______________, 2023.
in care of / rural route 555 Freedom Parkway, Atlanta, Georgia Zip exempt
united states of America

By: _______________________________

By: Alyssa-Dionne: Daniels, Agent seal

Georgia State

Fulton County

On ____________________________________, 2023, sworn and signed before me,

as Notary and as Jurat Certificate of Acceptance by court officer, all parties above
personally appeared and proved to me on the basis of satisfactory evidence to be the
living, breathing, sentient being, on the land, a man or woman over the age of 18; and
therefore is not and cannot be any artificial person or corporation; whose Name is
subscribed to the within attached instrument and acknowledged to me that he or she

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 Record of Parentage
and Statement of Non-Corporate Status

executed the same in his or her authorized capacity, and that by his or her autograph on
the instrument the parties executed, the instrument.
I certify under PENALTY OF PERJURY under the lawful laws of Georgia State and the
STATE OF GEORGIA that the foregoing paragraph is true and correct

Witness my hand and official seal.

Signature_______________________________ seal

of Notary Republic

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