Constructive Notice

Invoice Number: <invoice number on non-UNCITRAL BOE]> Date: <date of mailing>
Accepted for Value, Certified and Good
NON-NEGOTIABLE DISCHARGE ARTICLE # <registered mail #
To: Juan Carlos Puig Morales and/or Office Holder STANDARD

d/b/a Secretary of the United States TRANSFERABLE
Treasury of the United States Government
c/o DEPARTMENT DE HACIENDA
D/B/A TRUSTEE, INTERNAL REVENUE SERVICE
Post Office Box 9024140
SAN JUAN, PUERTO RICO [00902-4140]
<California> UCC Contract Trust
Account Number: <File # of first
UCC-1 to Secy of State>
VERIFIED ACTUAL AND CONSTRUCTIVE NOTICE
Attention: Juan Carlos Puig Morales and/or Office Holder, Respondent:
I, <Fawn Cheri Johnston, FCJ> ® <year of your registry>, the undersigned affiant, hereinafter,
Undersigned, does herewith solemnly certify and affirm on the Undersigned's unlimited
commercial liability that:
1. The Undersigned is competent to state the matters set forth herewith.

2. The Undersigned has personal knowledge of the facts herein.
3. That ALL the facts stated herein are true, correct, complete, and certain.
Admission as Evidence, and if testifying, the Undersigned shall state:
PLAIN STATEMENT OF FACTS
4. This constitutes an Actual and Constructive NOTICE that the Undersigned, <Fawn Cheri
Johnston, FCJ> ® <year of your registry>, herewith Accepts For Value the attached
Documents/Instruments with all related bona fide endorsements, front and back, in
accord with the rules of SEC and the Uniform Commercial Code (UCC) 1-103, 1-507, 1-
308, 3-419, 3-402, and House Joint Resolution (HJR) 192 of June 5, 1933, and UCC 1-
104, 10-104.
5. Respondent is herewith Authorized to Discharge to Account # <SSN without dashes>, of
the Undersigned's, for the appropriate registration fees and command the memory of
Account # <SSN without dashes>to charge the same to the Debtor's Order, or to
Respondent’s Order.
6. This Total Amount of this Acceptance For Value in this enclosed filing is <$590,500.00,
Five Hundred Ninety Thousand and Five Hundred> U.S. Dollars. Discharge the Public
Debt dollar for dollar.
7. Turnaround Rules of the Securities and Exchange Commission allow 20 business days to
provide the account Transcript in response to a request. Please send Notice to the
Form # VACN091710 Page 1 of 3

Undersigned of the Adjustment of this Account as requested herein within 20 business
days of Respondent's receipt and execution of this Verified Actual and Constructive
Notice, verifying confirmation from the Respondent that the Undersigned's Account has
been adjusted as herein requested.
8. In the event the Respondent requires further information and/or assistance from the
Undersigned, the Undersigned has provided a mailing address below.
VERIFICATION
9. The Undersigned Affiant, <your name, initial caps> ® <year of your registry>, does
herewith certify and Affirm on the Undersigned's unlimited commercial liability, that the
Undersigned Issues the ACTUAL AND CONSTRUCTIVE NOTICE WITH THE
SINCERE INTENT THAT THE Undersigned is competent to state the matters set forth
herein, that the contents are true, correct, complete, and certain to the best of the
Undersigned's belief, knowledge, and understanding, and in accordance with the
Undersigned's deeply held spiritual beliefs.
* NOTICE TO THE AGENT IS NOTICE TO THE PRINCIPAL *

* NOTICE TO THE PRINCIPAL IS NOTICE TO THE AGENT *
INVOICE NUMBER: <Invoice No. of this document above> ARTICLE # <pay pack RR#
Signed: ___________________________________
Executor/Executrix
Employer Identification # 515529929 c/o <your name, initial caps> ®

<year of your registry>
UCC Contract (Private) Trust Account #6555320 <your street address>
Post Registered Deposit Account Number: <your city, state [zip]>
<# of first registered mail>
STATE OF CALIFORNIA )
) ss:
COUNTY OF SAN DIEGO )
On this _________ day of ______________________, in the year 2015, before me,
______________________________, personally appeared ______________________________

and proved to me on the basis of satisfactory evidence to be the person whose name is subscribed
to the above instrument and acknowledged to me that she executed the same in her authorized
capacity, and that by her signature on the instrument, the person, or entity upon behalf of which
the person acted, executed the instrument.
WITNESS my hand and official seal.
____________________________________________
Signature of Notary Public

Notes:
* This Notes section is for explanatory purposes only and is not to be part of your official
document. Save this template as your official document and then delete this page so that the
page numbers will be correct.
* The Invoice Number at the top of this document is the Invoice Number on the non-
UNCITRAL International Bill of Exchange that accompanies this pay package.
* The amount of the discharge in #6 should be the amount of the debt plus an additional 20% as
a built-in handling fee for the Feds.
* The <File # of first UCC-1 to Secretary of State> is the filing number from the first UCC
package that you sent to your birth state or region.
* The <pay pack RR number> is a NEW United States Postal Service Registered Mail number
for this pay pack.
* The <# of first registered mail> is the United States Postal Service Registered Mail number
from the first UCC package that you sent to the Treasury Department.
* The Article No. is the RR number used in this pay package and must be consistent throughout
this pay package.
* The Notary Public statement at the end of this document is state-specific and should be
changed to match that required in the state in which you are getting the document notarized.
Check with a notary or online for the wording that you should use.
* The footer should contain a form number you make up. We suggest that it should consist of
the letters BOE (to indicate the document type), followed by the current date without spaces.
Example: BOE091710. To edit the footer in Microsoft Word, select View  Header and Footer.
This brings up a control bar and the cursor is active in the header, which is blank in this
document. To edit the footer, click the icon that switches between the header and the footer. Edit
the footer in your document. To save the modified footer and return to the body of the
document, click Close in the control bar.

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Constructive Notice

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Invoice Number: <invoice number on non-UNCITRAL BOE]> Date: <date of mailing>

Accepted for Value, Certified and Good

NON-NEGOTIABLE DISCHARGE ARTICLE # <registered mail #

To: Juan Carlos Puig Morales and/or Office Holder STANDARD

VERIFIED ACTUAL AND CONSTRUCTIVE NOTICE

Attention: Juan Carlos Puig Morales and/or Office Holder, Respondent:

1. The Undersigned is competent to state the matters set forth herewith.

PLAIN STATEMENT OF FACTS

Form # VACN091710 Page 1 of 3

* NOTICE TO THE AGENT IS NOTICE TO THE PRINCIPAL *

Employer Identification # 515529929 c/o <your name, initial caps> ®

, personally appeared

WITNESS my hand and official seal.

Form # VACN091710 Page 2 of 3

Form # VACN091710 Page 3 of 3

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