Invoice No: <initials, BC # (no dashes), and invoice #> <Date>

Accepted for Value, Certified and Good

To: Department of the Treasury Office of Executive Secretary

1500 Pennsylvania Avenue, NW
Room 3413
Washington, DC 20220

Internal Revenue Service NEGOTIABLE

DEPARTMENT DE HACIENDA TRANSFERABLE
c/o Francisco Pares Alicea
D/B/A TRUSTEE, INTERNAL REVENUE SERVICE
Post Office Box 9024140
SAN JUAN, PUERTO RICO [00902-4140]

BILL OF EXCHANGE
UNCITRAL
FEDWIRE AUTHORIZATION TO SETTLE ACCOUNT
IRM 3.8.45.5.10.1 (11-04-2011)

In re: FEDWIRE AUTHORIZATION TO SETTLE AND DISCHARGE ACCOUNT IN

ACCORDANCE WITH IRM 3.8.45.5.10.1 (11-04-2011); Federal Reserve Act of 1913
as amended March 9, 1933; Title 12 United States Code Annotated; and the Uniform
Commercial Code, Sections 1-103, 1-104, 1-105, 1-308, 3-419, and 3-402, and IRM
3.8.45.5.10.1 (11-04-2011)

<STATE> State UCC Contract (private) Trust Account Number: <File # of first
UCC-1 to Secretary of State> The Undersigned's personal I.D. Account Number: <SSN
without dashes> Posted Registered Treasury Deposit Account Number: <# of first Certified
mail # to Treasury>

Attn: Janet Louise Yellen and /or Office Holder, Respondent,

Enclosed are documents, i.e. copies, from the Undersigned's examination of the Commercial
Agreements of the Undersigned's that are listed on the enclosed accounting, with receipts and
other evidence that the Undersigned has accepted for Value (Banker's Acceptance), including all
related endorsements, front and back, to include all endorsements in accord the UCC 3-419,
Certified and Good and Sworn on the Undersigned's Commercial Liability, from the
Undersigned's Pre-Paid Account. The total Amount of this discharge is for <$000,000.00, Spell
out in words the dollar amount> in United States Dollars.

Please DISCHARGE, or cause to be Discharged, to Account Number < Social Sec # no dashes>
for the same value, and charge said Account for the fees necessary for securing and registration,
for the Priority Exchange for the Tax Exemption to Discharge the Public (DEBT) Liability, of
the Undersigned's personal possessions (Property). Command the memory of the Account

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Number <SSN without dashes> to charge the same to the Debtor's Order or to the Respondent's
Order.

This Posted Registered Deposit Account # <# of first UCC Contract Trust Certified mail #>
fund, that is part of the Undersigned's tax estimate, is directed for the priority use of the
Republic, Article Four, Section Four, Constitution of the United States of America, in discharge
of public debt.

Janet Louise Yellen and/or Office Holder, Secretary-in-Charge, or the Treasury

Department's Deputy Secretary-in-Charge, is directed to take the Undersigned's Banker's
Acceptance of this Article Seven receipt, in exchange for the tax exemption priority. This
INTERNATIONAL BILL OF EXCHANGE is presented for the receiver at the Federal Window
for Immediate Settlement, within the 72-hour period, re: Truth in Lending Act, time for
settlement of retail sales.

With this Posted Transaction, the Discharge documented by the enclosed forms, for use of/by the
Republic, is complete.

Please adjust the Undersigned's Account forthwith, in conjunction and Coordination with all
appropriate or involved agencies. Please send Notice to the Undersigned of this Adjustment as
requested within thirty (30) days.

Should Respondent require more information or assistance from the Undersigned, please contact
the Undersigned at the mailing address below.

ACCEPTED FOR VALUE, CERTIFIED AND GOOD

ATTACHED INVOICE NUMBER: <Invoice No. of this document above>,
ARTICLE No. <Certified mail number for this pay package>

NOTICE TO THE AGENT IS NOTICE TO THE PRINCIPAL

NOTICE TO THE PRINCIPAL IS NOTICE TO THE AGENT

Pre-paid: preferred stock; priority exchange; exempt from levy

_____________________________
<ALL CAPS NAME>
TIN: <SSN with dashes>
c/o UCC 1-103, 1-105, 1-308, 3-419
<your street address>
<your city, state> [<zip>]
_______________________________
<your name, initial caps>
EIN: <SSN without dashes>
UCC 1-103, 1-105, 1-308, 3-402
Authorized Agent / Representative:
UCC 1-103, 1-105, 1-308, 3-402
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This is the chargeback stamp that should be written or transposed onto the bill/presentment. It
should be endorsed by the Secured Party Private bank with a UCC Contract Trust Account
established with the Treasury. Remember: Your 1st Certified Mail No. to the Treasury is your
account number so do not lose that number.

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 Notes on Use of this Template

* 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.

* You must use and place the Banker’s Acceptance stamp diagonally on the
bill/present/invoice from the creditor/company before you submit them to the Treasury for
discharge. Please see the Banker’s Acceptance Stamp above. The EIN is your Social Security
Number with no dashes.

* The Invoice Number at the top of this document is a number that you make up. It should
start with your initials, followed by your birth certificate number, followed by a dash and the
number of the current Bill of Exchange. Example: RP51039924-1. Over time, you may have
multiple Bills of Exchange, and the number after the dash is to be incremented on each
consecutive one.

* The amount of the discharge in #1 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 <# of first certified mail> is the United States Postal Service Certified Mail number
from the first redemption UCC package that you sent to the Treasury Department.

* The Article No. is the Certified Mail number used in this pay package and must be
consistent throughout this pay package.

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.

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