Issued by: John-Henry: Doe, Principal Bond number: 985681515381JHD

c/o temporary mailing location: Bond Value: Unlimited

c/o U. S. P. O. Postmaster, Issue date: January 01, A. D. 2011
c/o the General Post Office
at Dallas, county of Gregg,
The State of Texas, The United States of America

DHL Airbill Tracking Number 985681515381

Issued for: Timothy Geithner, Secretary of the Treasury
Department of the Treasury
c/o 1500 Pennsylvania Ave NW
Washington, D.C. 20220

PRIVATE BOND FOR SET-OFF, NON-NEGOTIABLE

Value of Bond is Unlimited
In the matter of: Certificate of Birth No. 136-145-00006, Accepted for Value and Exempt from Levy
Credit to the Department of the Treasury and Charged to: JOHN HENRY DOE, 123-45-6789

The undersigned Principal: John-Henry: Doe, herewith accepts for value the enclosed instrument
entitled: "Certificate of Birth", numbered: 136-145-00006, 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. This is done in full accord with Public Law
found at Chapter 48, 48 Stat. 112, Public Policy found at House Joint Resolution: 192 of June 5, 1933, and
the Uniform Commercial Code.

BOND ORDER
Please deposit this bond as a credit to an account, bearing the DHL Airbill Tracking Number 985681515381 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 Birth" numbered: 136-145-00006, or any bills, taxes, or claims, and the
like, against the Debtor: JOHN HENRY DOE., 123-45-6789 (JOHN HENRY DOE) is Debtor to John-Henry: Doe, Secured
Party, as listed on the enclosed U.C.C.-1 Financing Statement), 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 HENRY DOE, 123-45-6789, to
zero or to a balance favorable to me, the Principal.

Timothy Geithner, 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 Geithner'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 Department of the Treasury,
and expires at the moment the Principal: John-Henry: Doe, dies. All Rights Reserved.

______________________________________ Seal
______________________ John-Henry: Doe, Principal
Right Thumb Print Exemption ID # 12-3456789

Witness #1: ______________________________ Witness #2: ______________________________

Print Name: ______________________________ Print Name: ______________________________