Issued by:

John Henry Doe

c/o P.O. Box 811
Bayside, California [95524]
Non-domestic without the US

Issue date:
Bond number:
Bond value:

30 October 2008
RRxxxxxxxxxUS
Unlimited

Issued to:

Henry M. Paulson, Jr., Secretary of the US Treasury

The United States Department of the Treasury
c/o 1500 Pennsylvania Ave NW
Washington, D.C. [20220]

REGISTERED MAIL
RETURN RECEIPT REQUESTED
REGISTERED NO. RRxxxxxxxxxUS

PRIVATE BOND FOR SET OFF - NON-NEGOTIABLE

Value of Bond is Unlimited
Re:

CERTIFICATE OF LIVE BIRTH #999999999 ACCEPTED FOR VALUE and EXEMPT FROM LEVY
CREDIT TO US TREASURY AND CHARGE TO JOHN H DOE 123-45-6789

The undersigned Principal: John Henry Doe, herewith accepts for value the enclosed instrument entitled: "Certificate of
Live Birth", numbered: 72-031356, and all endorsements front and back. The Principal is (1) the only legitimate acceptor of said
instrument, (2) the only party to have put any value to said instrument, and (3) the contributing beneficiary of the same.
BOND ORDER
Please deposit this bond as a credit to an account, bearing the Registered Mail tracking number: RRxxxxxxxxxUS for
future identification purposes, to be used as a set-off against any bills, taxes, or claims, and the like, against the Principal: John Henry
Doe, as listed on said "Certificate of Live Birth" numbered: 999999999, or any bills, taxes, or claims, and the like, against the Debtor:
JOHN H DOE 123-45-6789, with said claim(s) being accepted and endorsed by the Principal: John Henry Doe.
Please set-off any bills, taxes, or claims, and the like, issued against the Principal: John Henry Doe, as listed on said
"Certificate of Birth", or issued against the said JOHN H DOE 123-45-6789, to zero or to a balance favorable to me, the Principal.
Henry M. Paulson, Jr., Secretary of the Treasury, Department of the Treasury, has thirty (30) days from the date of
delivery of this non-negotiable, private bond for set-off, as witnessed by the signature affixed to the United States Postal Service
"PS Form 3811" [Return Receipt], to dishonor this Bond by returning it to the Principal at the exact, mailing location shown above.
Failure to return this Bond within the time stated above shall constitute Secretary Paulson's acceptance of this bond, his agreement
to honor this Bond, and his agreement to set-off all associated transactions and claims submitted to the Department of the Treasury
by the Principal, as they occur, in full accord with Public Law, Public Policy, and the terms and conditions contained herein.
This Bond shall be ledgered as an asset as best suits the needs of The United States Department of the Treasury.
This Bond expires at the moment the John Henry Doe expires.

_______________________________
Sally Marie Jones Surety #1
Exemption ID # 123456789
c/o P.O. Box 21221
Huntington Beach, California [92648]
Non-domestic without the US

Seal

____________________________
William John Smith Surety #2
Exemption ID # 123456789
c/o P.O. Box 40221
Arcata, California [95521]
Non-domestic without the US

Seal

____________________________________
John Henry Doe Principal
Exemption ID # 123456789
c/o P.O. Box 81182
Bayside, California [95524]
Non-domestic without the US

Seal