country of Georgia state/Republic
fulton county
RECORDING REQUESTED BY:
James Johnson
c/o 2011 Plaza Lane #326, Southwest
Atlanta, Georgia republic, usA
NON-DOMESTIC
Affidavit: Waiver of Religious Exemption - Vaccines
TO: ________________________________________
TO WHOM IT MAY CONCERN:
The purpose of this NOTICE is to give you, your office, and your Principles/Agents constructive
LEGAL NOTICE of my ABSOLUTE RE
3LIGIOUS & MORAL OBJECTION TO AND REFUSAL OF THE VACCINATION
PROGRAM instituted by _______________________________.
Administering vaccines is NOT mandatory under ANY federal, State or local law in these united
states of America, AND that _________________________________ CAN NOT COMPEL ME OR
MY CHILDREN AGAINST OUR WILL TO ACCEPT, RECIEVE or SIGN any VACCINATION
PROGRAM under THREAT, DURESS or COERCION without subjecting
_________________________________ to serious liabilities in this matter and deprivations of rights
under color of law.
That any intimidation or harassment regarding my ABSOLUTE RELIGIOUS & MORAL
OBJECTION AND REFUSAL will result in criminal prosecution under Title 42 §2083. You personally
or severally, and the institution you represent, may be liable for damages and attorney's fees.
I am a Hebrew American as defined 1828 Webster’s Ed. Dictionary, “American, noun, A native of
America; originally applied to the aboriginals, or copper-colored races, found here by the Europeans; but now
applied to the descendants of Europeans born in America, ”I am NOT an artificial person, or a corporation, I AM a
breathing man created by the most High I AM THAT I AM descendant of Adam()ָאדָ ם.
Psalms 64:2-5 2Thou hast sheltered me from the conspiracy of them that do wickedly; from the multitude of them that work
iniquity; 3who have sharpened their tongues as a sword; they have bent their bow maliciously; 4to shoot in secret at the
blameless; they will shoot him suddenly, and will not fear. 5They have set up for themselves an evil matter, they have given
counsel to hide snares; they have said, Who shall see them?
Psalms 91:5-8 5Thou shalt not be afraid of terror by night; nor of the arrow flying by day; 6 nor of the evil thing that walks in
darkness; nor of calamity, and the evil spirit at noonday. 7A thousand shall fall at thy side, and ten thousand at thy right hand; but
it shall not come nigh thee.
Isaiah 54:17 17I will not suffer any weapon formed against thee to prosper; and every voice that shall rise-up against thee for
judgment, thou shalt vanquish them all; and thine adversaries shall be condemned thereby. There is an inheritance to them that
serve the Lord, and ye shall be righteous before me, saith the Lord.
Affidavit: Waiver of Religious Exemption - Vaccines
Page 1 of 2
Thank you for your respect.
Constructive Notice issued by:___________________________________________________
Representing:_________________________________________________________________
Witness 1: _________________________________ Date: ________________
Witness 2: _________________________________ Date: ________________
Affidavit: Waiver of Religious Exemption - Vaccines
Page 2 of 2