Form SSN Citizen's Assertion of Legal Right
to withhold disclosure of SSN

u Public Law-93-579 (Section 7)

Name and address of Citizen Name and address of Notice Recipient

Citizen's statement:

I certify that the forgoing information stated here is true and correct.

Citizen's signature
u Date u

Legal Notice and Warning
Federal law provides that it is a crime to violate the Rights of a
citizen
under the color-of-law. You
can be arrested for this crime and can also be held personally liable
for
civil damages.

Federal Law, Section 7 of Public Law 93-579 provides that: "It shall be
unlawful for any Federal, State or local government agency to deny
to any individual any right, benefit, or privilege provided by law
because
of such individual's refusal to disclose his social security account
number." Federal courts have ruled the Privacy Act applies equally
to the private sector.

Warning, you are in violation of Federal Law and persisting with your
demand may lead to your arrest and/or civil damages! The law provides
that
you can be held personally responsible and liable, as well as your
company
or agency.

There is no law requiring an individual to obtain or use a social
security
number. Your requirement and/or demand that I provide a social security
number to you is a violation of one  or more of the following laws: 4
CFR 83.9; 5 USC Sec. 552a; 7 CFR 1.123; 7 USC Sec. 2204g;
14 CFR 1212.604; 17 CFR 249.501a; 19CFR 118.11; 19 CFR 122.25;
19 CFR 24.5; 24 CFR 5.212; 28 CFR 16.53; 28 CFR 513.31;
28 CFR 700.25; 29 CFR 70a.10; 29 CFR 71.12; 31 CFR 1.32; 31
CFR 501.806; 32 CFR 270.19; 32 CFR 310.20; 32 CFR 311.5;
32 CFR 316.6; 32 CFR 317.20; 32 CFR 323.5; 32 CFR 505.2;
32 CFR 701.108; 32 CFR 806b.9; 38 CFR 1.575; 38 CFR 3.216;
38 USC Sec. 5101; 39 CFR 266.4; 45 CFR Part 801;  47 CFR 0.554;
49 CFR 10.29.

You are advised to cease and desist with your demand and to seek
personal
legal counsel if you do not understand the law.

Notice of Service:
I, certify that I personally delivered this notice to above named
recipient
and address on at .

42 USC Sec. 408 provides that: "Whoever ... (8) discloses, uses, or
compels
the disclosure of the social security number of any person
in violation of the laws of the United States; shall be guilty of a
felony
and upon conviction thereof shall be fined under title 18 or imprisoned
for not more than five years, or both."
18 USC §242 and 42 USC §1983 provides that: Whoever, under color of any
law, statute, ordinance, regulation, or custom, willfully subjects any
person
in any State, Territory, or District to the deprivation of any rights,
privileges,
or immunities secured or protected by the Constitution or laws of the
United States,
... shall be fined under this title or imprisoned not more than one
year,
or both;" 42 USC §1983 further provides that a violator "shall be liable
to
the party injured in an action at law, suit in equity, or other proper
proceeding for redress."
Public Domain-Privacy Form SSN(02) 2000