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-NonAssumpsit)
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!