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Re: CERTIFICATE OF BIRTH # 100-87-000000 ACCEPTED FOR VALUE and EXEMPT FROM LEVY
First Middle : the House of Last - Principal Surety #1– Polinski,Peter,Joseph Surety #2 – Tevolitz,Laurel,Nancy
Exemption ID # SSSSSSSSS Exemption ID # 090720013 Exemption ID # 045509723
c/o 1234 Main Street c/o 420 Jeannette Drive c/o 8105 Redlands Street, # 106
Monroe, Calfiornia; Near [00000] Utica, New York; Near [13502] Playa del Rey, California; Near [90293]
Non-Domestic without the US Non-Domestic without the US Non-Domestic without the US
________________________ __________________________
______________________
Witness #1 _______________________ Witness #2 _________________________________
c/o _______________________________ c/o _________________________________________
______________________; Near [ ] _______________________________; Near [______]
Non Domestic without the US Non Domestic Without the US
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