_____________________________________________________________________________

FOR THIS CLAIM OF THIS LIFE IS WITH THIS CLAIM BY THIS CLAIMANT. ~1
~1

FOR THIS CLAIMANTS-KNOWLEDGE OF THIS LIFE IS WITH THIS CLAIM OF THE

LIVEBIRTH-NAME: John-Henry:
___________________________________________,
ON THIS
Doe
DATE~____
IN THE YEAR~_________,
4 DAY, OF THE MONTH~___________________,
APRIL
1974
BY THIS WITNESSING-CLAIMANT.

~2

FOR THIS CLAIMANTS-KNOWLEDGE OF THIS LIFEBIRTH IS WITH THE LOCATION IN

THE CITY~__________________________,
STATE~_________________________,
HUNTINGTON BEACH
CALIFORNIA
TERRITORY~______________________,
COUNTY~____________________(U.-S.-A.)
CALIFORNIA
ORANGE
BY THE PARENTS: FATHER:________________________________,
Michael-Andrew: Doe
MOTHER:________________________________.
Julie-Marie: Edwards

~3

FOR THESE WITNESSES OF THIS LIFEBIRTH IS WITH THE CLAIM OF THE CLAIM
OF THE LIFE-CERTIFICATE:_____________________________,
Charles-William: Smith
:_____________________________,
:_____________________________.
Daniel-Robert:
Jones
Sally-Marie: Fields

~4

FOR THIS PICTURE, FINGERPRINT-SEAL AND DNA-SAMPLE OF THIS CLAIMANT ARE

WITH THESE CLAIMS OF THIS FACTUAL-LIFEBIRTH:
PICTURE:

FINGERPRINT:

:________________________________
:AUTOGRAPH-WITNESS:

:________________________________
:AUTOGRAPH-WITNESS:

DNA-BLOOD/SALIVA:

:________________________________
:AUTOGRAPH-WITNESS:

:________________________________
:AUTOGRAPH-CLAIMANT-LIFEBIRTH:

FOR THIS COPYRIGHT/COPYCLAIM ~6~NOVEMBER~2008 BY THIS John-Henry: Doe OF THESE UNITY-STATES OF

THIS CORPORATION-VESSEL WITH THE UNITY-STATES OF OUR-WORLD-CORPORATION AND WITH THIS LIFEBIRTHCLAIMANT.