RESCINDING YOUR SOCIAL SECURITY NUMBER

Requirements:
 4 Cover letters for both the local & main building of the Internal Revenue
Service (IRS) & Social Security Administration (SSA).
 Application for REVOCATION of false Social Security Card.
 Authorization to disclose information to the SSA
 Affidavit to Correct the Record to Rescind All Signatures on All Social
Security SS-5 forms
 Actual & constructive legal notice U.C.C. 1-201(25)(26)(27)
 Form 56 – Notice Concerning Fiduciary Relationship
 Verification of Identity by Public Official
 Request for withdrawal of application
 Resolution No.75 (optional)

You’ll need to have these files printed out 5 times.

4 files are for sending out to the multiple locations of the IRS & SSA.

The extra copy is for your private records. To be on the safe side, make another

for yourself & have it saved at a different location (This is optional).

 The 4 Cover Letters

The 1st cover letter will be going to Carolyn W. Colvin, the current head of the

SSA.

Carolyn W. Colvin
Social Security Administration
Office of Public Inquires
1100 West High Rise
6401 Security Blvd
Baltimore, MD, 21235

The 2nd cover letter will be going to John Koskinen, current commissioner of the

IRS

Office of the Commissioner

Internal Revenue Service
1111 Constitutional Ave. N.W.
Washington, DC 20224
Phone: 202-622-9511
 Attention: John Koskinen

The other two cover letters will be going to the local IRS & SSA buildings within

your city/town/district near you.

All mail outs must be certified mail & the certified mail numbers will be on each

cover letter. Each cover letter has to be notarized.

REVOCATION of the FALSE Social Security Card

Box #1 NAME:

Name to be shown on card - Upper-lower case first & last name (skip middle)

Full name at birth if other than above – ALL CAPS first/last name (SKIP! Middle)

Other names used – (Never consented to apply and cannot lawfully consent to

apply without committing a crime in violation of 20 CFR 422.104, 18 USC 911,

and 18 USC 912. All rights reserved from birth to death. UCC 1-308.)

Box #2 ILLEGAL SSN ASSIGNED TO INDIVIDUAL: Your SSN#

Box #3 PLACE OF BIRTH: North America

Box #4 DATE OF BIRTH: MM/DD/YYYY

Box #5 CITIZENSHIP: Legal Alien Allowed To Work

Box #6-11 ETHNICITY/RACE/SEX/PARENT’S MOTHER’S NAME AT HER

BIRTH & SSN/PARENT’S FATHER’S NAME & SSN/INFO IF ANYONE HAS

FILED FOR SSN ON THE BEHALF OF PERSON IN BOX #1: SKIP!

Box #12 NAME SHOWN ON MOST RECENT SS CARD: Same. Person on card

in connection with SSN is an ILLEGALLY CREATED public office that I don’t

consent to represent and can’t lawfully represent (straw man).

Box #13 Different DOB if used on an earlier application: Skip.

Box #14 TODAY’S DATE: The date you send out the application

Box #15 DAYTIME PHONE NUMBER: Skip.

Box #16 MAILING ADDRESS: This document is false, fraudulent, and

PERJURIOUS unless accompanied by Resignation of Compelled Social Security

Trustee document signed and attached.

Box #17 YOUR SIGNATURE: Your signature.

Box #18 YOUR RELATIONSHIP TO THE PERSON IN ITEM 1: Check the Self

box & on the Specify line put Registered Owner

 AUTHORIZATION TO DISCLOSE INFORMATION TO THE SSA

WHOSE Records to be Disclosed: ALL CAPS NAME on SS Card (Including

middle), DOB mm/dd/yyyy, & SSN.

Read all the information on the page & when you get to PURPOSE check box

that says: Determining whether I am capable of managing benefits ONLY

Sign the form in blue or black ink to authorize the disclosure, your street address,

city, state, & (zip)

Have two witnesses sign their name (a phone# & address is optional but it’s not

needed).
Affidavit to Correct the Record to Rescind All

Signatures on All Social Security SS-5 forms

The form will be a sworn statement of you stating the following:

1. My appellation is (name), I am the beneficiary, principal and

executor of the (ALL CAPS NAME) estate.

2. I am over 21 years of age, of sound mind and I have personal

knowledge of the facts stated below.

3. I am at the age at which the law considers one an adult and entitled
to legal rights (beyond those of the age of capacity).

4. The purpose of this affidavit is to serve as evidence that I have

rescinded all signatures on all Social Security SS-5 forms.
5. This affidavit complies with the rules of evidence and is admissible
in any tribunal, court or domestic/foreign office in the United States
and the United States of America.

6. This affidavit establishes my personal knowledge and authenticity.

7. The purpose of this affidavit is a notice to all that I am competent to

handle all my affairs.

8. I am not a public officer/state or federal employee/government

employee/indentured servant or a slave paying into another pension
program in the United States.

Sign your name on the form, fill in state of (State), parish of (city/county), & have

a notary notarize the paperwork.

Actual & Constructive Legal Notice U.C.C. 1-201(25)(26)(27)

This form is a legal statement of you are “Non-Assumpsit”, “Non-Domestic and

Non-Federal” in the regards to the UNITED STATES and/ or any of its

“Constitutes STATES”

(READ THIS!) It is important that you correct the current state you are living in.
Sign your name as the secured party & get it notarized.

Form 56: Notice Concerning Fiduciary Relationship

This editable file must be done at http://www.irs.gov/pub/irs-pdf/f56.pdf to edit

with the following instructions:

Part I: Identification

Name of person: (ALL CAPS NAME), Federal “trustee” and “public office”

Identifying number: SSN 123-45-6789

Address of person for whom you are acting:1111 Constitution Ave, N.W.

(domicile of “public office” pursuant to Fed. R.Civ.17(b))

City or town, state, & ZIP code: Washington, District of Columbia 20224; “United

States” (District of Columbia as defined in 26 USC 7701 (a) (9) and (a)(10))

Fiduciary’s name: Your-Name:, unenumerated private human being protected by

the Constitution

Address of fiduciary: Your address (Non-Domestic/Non-Assumpsit)

City or town, and ZIP code: City, State; united States Of America (not “United

States)
Note: united States is the way it must be written, it is not a typo in case you were

wondering.

Section A. Authority

1. Check box F for other: Resignation From Social Security (see

attached)

2a. Skip.

2b. Skip.

Section B. Nature of Liability and Tax Notices

3. Type of taxes: Check all boxes & describe for other as All

4. Federal tax form number: Check all boxes & describe for other as All

5. Skip.

6. Skip.

Part II: Court and Administrative Proceedings

Name of court: N/A

Part III: Signature

Fiduciary’s signature: Sign.

Title, if applicable: Human being never lawfully a fiduciary.

Date: MM/DD/YYYY.

Verification of Identity by Public Official

BEFORE ME, the undersigned Notary Public, for the Parish of

, Republic of , on this
, day of , 2015, State that
, appear and was
identified.

WHO, upon first being duly sworn and/or affirmed, depose and says
that;
1. (Your Name) is an exclusively private human being NOT
representing any office or exercising any agency on behalf of any
government such as: “citizen,” “resident,” “taxpayer,” “driver,”
or “spouse.”

2. Who identity is described herein whose father's name is (Your

Father’s Name). Whose mother's name is (Your Mother’s Name,
Maiden Name if not married).

3. Born at (Hospital Name or birth place) on the (Day)of (Month),

in the year (Your Birth Year).

4. Whose eyes are the color of (Eye Color), standing at a (Height), hair
the color of (Color).

5. The affixed picture and all information on this affidavit are true to
the best of his knowledge and belief. (Attach Passport Photo To Form)

6. The human being who appeared before me provided the following

signature:

Have this form notarized.

Request For Withdrawal Of Application

Name of wage earner, self-employed individual, or eligible individual: (ALL CAPS

NAME)

Social Security Number: 123-45-6789

If different, print your name: (Your-Name):, human being non-residence

Your SSN: N/A

Type of benefit you want to withdraw: Social Security/ALL

Date of application: You need to go to the local SSA office and get the date your

mother signed up for the SSN.

If applicable, do you want to keep medicare benefits: No.

Give reason for withdrawal: Check box #2 Other: I have never been eligible to

participate in this program because: 1) I never explicitly consented to participate;

2) I was lied about the effects of participation; 3) I never mentioned a legal

domicile in the “United States” as defined in the current social security act section

1101 (a)(2) 42 U.S.C. 1301(a)(2) as required by 20 CFR 422.104. I, therefore,

permanently & irrevocably wish to terminate participation & any number that was
unlawfully issued under the program & all contributions illegally withheld or sent

in to the returned to me as requested in the attached resignation from social

security document>

You will definitely need to check the “Continue on reverse” box.

Signature of person making request: (Sign ALL CAPS NAME), write without

prejudice above it.

Date: MM/DD/YYYY

Mailing Address: C/O (Your Address)

City and State: (City), (State) Republic (Non-Domestic/Non-Assumpsit)

ZIP Code: [#####]

Name of county in which you now live: (Your county) (Non-Domestic-Non-

Assumpsit)

Have two witnesses sign your form. Their addresses are optional but not needed.

(Note: This form must be filled out in blue ink besides the signature(s).)
Resolution No. 75
This is optional for those wanting to claim their Moorish American birthright & as

proof to have the right to carry the title(s) of our ancestors. Salaam!