STATE OF STATE CIRCUIT/COUNTY COURT

COUNTY OF COUNTY SOME JUDICIAL DISTRICT

In the matter of SOME NAME

Property of STATE OF BIRTH, Court File No. __________________________
STATE OF ISSUANCE,

JUDICIAL NOTICE OF EXERCISE OF RIGHT OF SET-OFF

I believe there is a mistake, as I am to assume full liability and responsibility for all actions and
inactions and take exception for all current and acquired issues for tax recovery and wish to
apply equitable interest from this event recorded to all issues in SOME NAME as set-off for
forgiveness and discharge of contractual obligations to pay in the future for considerations
presently received in fulfillment of the law.

Dated: ______________________
By: ___________________________,
authorized representative
for the represented person