SOCIAL SECURITY ADMINISTRATION
PO BOX 33018
BALTIMORE MD 21290-3018
To Whom it may Concern:
Declarant, ___________________________________________, is a competent witness and does Solemnly state that:
1. On or about April 17, 2001, I found in the mailbox I use, a window envelope bearing the return address:
SOCIAL SECURITY ADMINISTRATION
PO BOX 33018
BALTIMORE MD 21290-3018
and the captions:
OFFICIAL BUSINESS
PENALTY FOR PRIVATE USE, $300
TO BE OPENED BY ADDRESSEE ONLY, UNDER PENALTY OF LAW, all printed in green ink.
2. Said envelope was addressed to:
A0109
THOMAS M. THORNHILL
BOX 1755 USPS
NEVADA CITY CA 95959-1755
[bar coding which I cannot read]
3. I marked said envelope "del. 4/17/01" in handwriting in black ink below the postage permit block.
4. I do not have personal knowledge of the referenced law which claims to prohibit me from opening said envelope. From fear of whatever unknown penalty is, or may be, attached to such an act, I am returning said envelope unopened at my own expense, because I feel that I am legally unable to open it.
5. I am not the fiduciary, executor, agent, attorney, or other representative for this "THOMAS M. THORNHILL" and I do not know who is, or may be.
6. The entity, which might have some relation to me, that SOCIAL SECURITY ADMINISTRATION created upon its SOCIAL SECURITY ACCOUNT NUMBER card is styled: "THOMAS M. THORNHILL, III".
7. If SOCIAL SECURITY ADMINISTRATION is attempting to contact that entity, it needs to correct its records and/or mailing lists.
8. If SOCIAL SECURITY ADMINISTRATION is attempting to contact me, I hereby give NOTICE that:
my proper name and mailing address are as set out in the upper left corner of this notice.
9. If SOCIAL SECURITY ADMINISTRATION should wish me to take any action in relation to the contents of said envelope, it needs to remail said contents in a timely manner in an envelope I am allowed to open, or to properly address the envelope.
10. I have no knowledge whatsoever of the contents of said envelope as of this date.
I certify under the laws of the State of California, that the foregoing is true and correct.
_______________________________________
date: ___________________________________
_________________________ city, __________________________ county, _______________ state, united states of America.