Scribd
Upload
1K views2 pages

Affidavit of Ownership Example

This document contains a 3-page affidavit of ownership for a birth certificate. It includes instructions to send certified letters to 3 parties (the Secretary of State where you were born, your State Registrar, and the Secretary of State in Washington D.C.) with a non-negotiable instrument claim number. The affidavit asserts ownership of the birth certificate and all associated estates and properties. It is signed and notarized. Attachments include the original birth certificate and its CUSIP number.

Uploaded by

hpvnsxngkh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
1K views2 pages

Affidavit of Ownership Example

This document contains a 3-page affidavit of ownership for a birth certificate. It includes instructions to send certified letters to 3 parties (the Secretary of State where you were born, your State Registrar, and the Secretary of State in Washington D.C.) with a non-negotiable instrument claim number. The affidavit asserts ownership of the birth certificate and all associated estates and properties. It is signed and notarized. Attachments include the original birth certificate and its CUSIP number.

Uploaded by

hpvnsxngkh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 2

Three separate letters with same RB number To:

-- Secretary of State where you were born


Certified Mail/Confirmation of Delivery/Validation Notice # xxxxx xxxxx xxxxx xxxxx xxxxx

-- Your State Registrar (Probate Judge)


Certified Mail/Confirmation of Delivery/Validation Notice # xxxxx xxxxx xxxxx xxxxx xxxxx

-- Secretary of State in Washington D.C.


Michael Richard Pompeo
c/o Office of the Secretary
1350 Pennsylvania Ave NW
Washington, DC 20004
Certified Mail/Confirmation of Delivery/Validation Notice # xxxxx xxxxx xxxxx xxxxx xxxxx

Non-negotiable instrument claim number RB XXX XXX XXX US

AFFIDAVIT OF OWNERSHIP

State of _________ )
) ss.
County of __________ )

Re: Birth Certificate

I, the undersigned, of lawful age and being first duly sworn on oath, depose and state that I am familiar with
the facts recited, and the party named in said Birth Certificate is the same party as one of the owners named
in said certificate of title.

I, YOUR FULL NAME (AS ON BIRTH CERTIFICATE) UPPER CASE, (heretofore and hereinafter
“Claimant”) having attained the age of majority and reason under divine law competent first-hand witness to
the truth and facts recited below, hereby makes a claim against the corpus, all property whether real or
personal, tangible or intangible, all deposit accounts blocked by reason of presumption of death of Claimant,
cash, credit lines, Credit default swap, all federal funds, collateralized debt obligation, options, derivates,
and futures received by the said court in the said county, state and federal for the administration of the
named estate, and all estates in agency, including but not limited to YOUR FULL NAME (AS ON BIRTH
CERTIFICATE) UPPER CASE or by whatsoever name the said estate shall be called or charged. I hereby
declare under penalty of perjury that the above information is complete, correct, and true to the best of my
knowledge. By: (your given name lower case i.e. john-henry: doe), Claimant

Authorized Representative: john-henry: doe


Attachments:
Original Birth Certificate
Birth Certificate CUSIP Number

Page 1 of 2
AFFIDAVIT/JURAT

This Affidavit/Jurat pertains to the foregoing page titled: "Affidavit of Ownership"

County _______________ )
) ss.
State_________________ )

i________________________________ A Notary Public do verified by my signature below, that


the man/woman _________________________ been known to and/or showing identification card
with picture. That the man/woman who now appears before me and signed his signature on the
preceding page in my presence and view, and did clearly state the following out loud in living
voice before me;: "all statements in my the foregoing pages are my truth, without intent to mislead,
and given on my unlimited liability, as my sworn testimony regarding "Affidavit of Ownership ":
[end quote]

Notary signature:________________________

Notary printed name:_____________________

My commission expires___________________

These pages are the sole property of i, a man/woman _________________

Authorized Representative ____________________________________

thumbprint
Date:______________

Page 2 of 2

You might also like