By: First Middle Last c/o rural route postal service address:

123 Voter Registration Address, City, State [ZIPCODE]

Return Address: :First-Middle; Last:

In Care Of / Rural Route 123 Street Name Road, City, Utah Republic Zip Exempt [near
ZIPCODE]
Social Security Account (a Private annuity account)
No. XXX-XX-0000
To: Voter Registration/Election Division, Office of Lt. Governor Henderson
PO Box 142325, Salt Lake City UT 84114
Regarding: Notice & Praecipe, elector status change
Cancellation of Voter Registration
REGISTERED MAIL #: RF 000 000 000 US

January 25th, 2022

To Whom it May Concern,
I, :First-Middle; .Last: do hereby make this declaration of my “Elector” Status as one of “we the
people”, a state national as defined in 8 USC Section 1101 (a)(21), (23), as one who elects their
representatives.
You will please take notice that I recently discovered that there are certain political
liabilities attached to the voter registration of a US Citizen which, had they been fully disclosed
to me at the time I was induced into Consent Contract, would have dissuaded me from doing so.
For that reason and on that basis, I am hereby repudiating the said contract and hereby rescinding
my signature from and declare void any and all forms, cards and instruments which may
evidence the said mistake.
You will also forthwith please remove my fiction dba name FIRST MIDDLE LAST
(minor account) from the voter rolls of the STATE OF UTAH and any political sub-division
thereof as well as notify any and all interested parties of this Elector status change. My
individual sovereign Consent is withdrawn and reserved until further notice. Acknowledgement
of the compliance of this change is required and much appreciated. In the event that you are
unable or unwilling to comply with this instruction then you agree by your acquiescence and
shall serve as the judgment. I shall alternatively require of you evidence of your Article IV Oath
of Fidelity as well as the policy number, name and address of the underwriter of your Bond or
your risk management agent.
I hereby declare my elector status as one of we the people who founded government, not as a US
Citizen or citizen (voter) created by the 14th Amendment of the Constitution, by government.
Please acknowledge my choice of “electoral status”.

Respectfully,

First Middle Last

Non-resident alien / American State National / Elector