P a g e | 1 of 6 Passport Application Assistance Assistance / HISAdvocates, HISAdvocates, s.s.m. 2973 Harbor Blvd. #475, Costa Mesa, California Dear HISA Member, Thank you for your interest in our services in assisting you with your true state nationality. To begin this process please complete and return the following: Completely read TWICE this page and the Hold the Hold Harmless Agreement. Agreement. If you then have any questions, questions, call us at 530-694-4343. 530-694-4343 . U.S. Passport Application Assistance Assistance with with counsel does not include what the Post office and the Federal U.S. government government charges, mailing charges, passport photo charges, or certified certified birth certificate charges. The assistance on the application will only be completed if you meet the following criteria. Born within within the united united States States of America America borders borders Currently not wanted for any felony felony offense by any US Federal Federal Agency and are are not on parole in any State State You desire to be recognized recognized on your your application as a state Citizen Citizen as defined defined in law That you recognize recognize that you are not giving giving up any status status or standing as a Citizen Citizen of both your state state and of th rd the de jure united States of America (Blacks 6 Def. of United States 3 Def) That you are NOT doing doing this to avoid prosecution prosecution or to get out of paying Federal, Federal, State or Local Local Income taxes.
Remember you MUST initial EVERY provision provision showing you understand the provision. This agreement will not be accepted unless every box is initialed. initialed. Please look as well for the two separate separate signature spots within the following agreement. Upload the filled in Passport Application and Fully Executed Hold Executed Hold Harmless Agreement to Agreement to your original support request here: https://www.hisadvocates.org/support/topics/the-exodus-program. https://www.hisadvocates.org/support/topics/the-exodus-program. You must either either pay $500 $500 FRNs (Federal Reserve Notes) or by PayPal. Checks or money Orders will NOT be accepted. If you like, you can send the amount in consideration along with your originals via UPS or FEDEX ONLY. Any delivery other than from UPS or FEDEX will be refused. refused. You are responsible responsible for all funds lost by mail; be sure to register register or track track the packages. If you are going to to send payment by PayPal, by PayPal, please make it for $515.00 to: $515.00 to: ministry@hisadvocate
[email protected] s.org that way you might might be able to use your your bank card or other means if you like. Once received, received, we will note note your support ticket ticket as such. VIP members members get a $100.00 $100.00 discount. discount. Simply deduct deduct that amount from from the total. total. After the first 50 members, the process is going to go up to $795 FRN’s. Preparation: 1. Go to the county recorder recorder of where where you were were born and get get a certified certified copy of your your birth certificate. certificate. 2. Go to your local Post Post Office, pick up and and fill out a New Passport Passport Application Application (Use this even even if you have a passport already). Or you can go to this website and use this form: http://www.state.gov/documents/organization/212239.pdf 3. Fill the application application out as best as you can. can. (You do not need to sign sign it or use the SSN) SSN) We We will not use this application for your final application. This application. This is a worksheet for me and will be returned to you or destroyed. 4. Send Send the the signed original copy of the Hold Harmless Agreement in the mail to: HISAdvocates, HISAdvocates, s.s.m. – Passport Assistance Department 2973 Harbor Blvd #475 Costa Mesa, California [92626] Once we have these documents and confirmation of consideration, we can begin work on you process.
P a g e | 2 of 6 We will LOOK FOR THE PAYPAL PAYPAL PAYMENT or CASH. Once consideration confirmed, confirmed, we will post consideration amount received to your support request. request. We will then call you once the documents documents and consideration are accounted for. Remember we will NOT be filing anything on your behalf. behalf. All documents documents will be sent back to you for you to sign and file with the Post Office yourself. Any questions at all please call us at 530-694-43 at 530-694-4343. 43. Phone number only for pre submitted application pertinent questions. Notice: All communications including phone calls will be recorded. Notice: After you have completed your Passport Application Application and Hold and Hold Harmless H armless Agreement, Agreement, all communication communication will be handled through the HISAdvocates.org portal where you originally submitted your support ticket request. INSTRUCTIONS: Please carefully read this Agreement, then: 1) Print your Print your name in the space in the first paragraph of the Agreement. 2) Initial EVERY Initial EVERY provision provision after you fully UNDERSTAND it. 3) On Page 5, print your name, name, mark [sign] and date this Agreement. Agreement.
The Purpose of this HOLD HARMLESS AGREEMENT is AGREEMENT is not to create a safety for HISAdvocates, for HISAdvocates, s.s.m and/ or HISAdvocates Directors or Assigns [hereafter Directors], Directors], but to promote an Honesty and Responsibility for the relationship being created on behalf of the one receiving the assistance the assistance of counsel. counsel. Black’s Law Dictionary defines Responsibility as follows: The state of being answerable for an obligation, and includes judgment, skill, ability and capacity. The obligation to answer for an act done, and to repair or otherwise make restitution for any injury it also defin defines es Assist Assistan ance ce of cou counse nsell as such: such: Sixth Amendmen may have caused. caused. It also Amendmentt to Federal Federal Constitu Constitution, tion, guaranteeing accused in criminal prosecution “ assistance assistance of counsel ” for his defense, means effective assistance as distinguished from bad faith, sham, mere pretense or want of opportunity for conferences and preparation.
________ Initial THE NEED FOR COUNSEL ASSISTANCE It is common knowledge that the legal system for the most part, (courts, attorneys and justices) is broken. Broken in the sense sense that that it as a whole whole is selfself-ser servin ving g and no longer longer commit committed ted to uphold upholding ing State and Feder Federal al Constitutions. It would seem that, many of the players in this system are NOT interested in securing Liberty and Freedom by protecting individual Rights, but are committed to protecting a system that secures position, power and their own prosperity. This system is committed to prosecuting non-criminals and criminals for profit and for litigating one party against another regardless as to whether or not there is an injured party. Truth is an irrelevant idea in a system of mystery-terms and language that only perpetuates itself, is the arena of the legal system. It is in this light that the strength of the words “ Assistance of Counsel” Counsel” and its meaning in the 6th Amendment of the Constitution is offered in this Hold this Hold Harmless Agreement. Agreement. Securing individual Rights with Faith, genuine Integrity and Honesty that Directors will endeavor to bring to the relationship as they offer their counsel assistance assistance through HISAdvocates, s.s.m. ________ Initial
P a g e | 3 of 6 HOLD HARMLESS/RELEASE AND ARBITRATION ARBITRATION AGREEMENT For For and in consid consider erati ation on of the the mutua mutuall promis promises es and agree agreemen ments ts set forth forth bel below ow,, HISAdvocates, HISAdvocates, s.s.m. (Hereinafter referred to as “HISA”) and HISAdvocates, s.s.m. Directors or Assigns (Hereinafter (Hereinafter referred to as “Directors ”) and (Your Full Name below) ____________________ _____________________________ ________________ _______ (Print Full Given and Surname) (Hereinafter Surname) (Hereinafter referred to as “I”) agree as follows: SECTION I: EXCLUSIVE NATURE TO RECEIVE IN COUNSEL COUNSEL ASSISTANCE 1. I I acknowledge the exclusive and private nature of this Counsel 1. this Counsel Assistance Assistance and and I disclose that I am NOT a U.S. citizen, (Federal citizen) nor do I live or work in any federal territory, possession, location or zone. I am NOT a resident alien nor alien nor am I a federal officer or agent. I acknowledge that I am NOT functioning in any “Trade or Business” as defined in Title 26 Section 7701(26). 7701(26). I disclose that I am NOT receiving any privilege or benefit from any State or Federal government. ________ Initial 2. I acknowledge the Private Nature of this service and copyright of the information I will be provided. I agree NOT to share the information others without permission and acknowledge the liability to myself for providing this information to others who may use it improperly. ________ Initial SECTION II: CONSENT TO RECEIVE IN COUNSEL ASSISTANCE ASSISTANCE 3. I ackno acknowle wledg dge e that that I am fully fully and satisf satisfact actor orily ily inform informed ed about about counsel assistance offered offered by HISA HISA and and Directors and that I freely and willingly am choosing to receive their counsel assistance assistance at at this time. ________ Initial 4. I understand that the counsel the counsel assistance may assistance may include written communications, communications, conversations in person as well as on the telephone, and I understand that I may freely choose whether or not I will receive, take and/or act upon said counsel said counsel assistance assistance.. Counsel assistance is assistance is NOT legal advice or counsel and should NOT be considered as such. ________ Initial 5. I understand that I am personally responsible for all my actions, including actions that are of a “legal nature,” and they are freely taken as my own, regardless of the counsel given and/or outcome. ________ Initial 6. I understand that the HISA is NOT a law firm and that Directors are NOT a “lawyers”, “bar attorneys” or paralegals. The counsel The counsel assistance assistance is is NOT psychotherapy, medical therapy or advice, neither is it a substitute for any of these. ________ Initial 7. I understand that the counsel the counsel assistance may assistance may or may not involve the facilitating of a “power of attorney” service, and if and if I do not consent to this, this , I will tell Directors that I object before or at the time the signing of such a
P a g e | 4 of 6 document. I further understand that the nature of dealing with the governing authorities, courts, police, Federal government, State government and my Rights, Freedoms and Liberties involves serious issues and I may experience, experience, including but not limited to: deep emotions and possibly emotional stress, anxiety, tears, physical discomfort, or exhaustion. I will anticipate this as my responsibility and will expect this to occur. ________ Initial 8. I do not have any doubts about my mental health and/or emotional stability with regards to handling the rigors of the counsel the counsel assistance assistance.. I have resolved any such doubts I may have had about the counsel the counsel assistance by assistance by consulting those who are knowledgeable about “legal matters”, including but not limited to, a lawyer, attorney, physician, psychiatrists, psychotherapist, psychotherapist, or psychologist. Such person(s) to my understanding have no objections to my receiving counsel receiving counsel assistance assistance.. ________ Initial 9. I understand HISA, their assistants and staff are not my fiduciaries and I do not expect the counsel the counsel assistance assistance to to be administered with the standard expected of trained legal professionals. If I feel that I am not getting the proper assistance I expect during the counsel the counsel assistance, assistance, I promise to inform Directors immediately. ________ Initial 10. I understand I am free to reject any aspect of the counsel the counsel assistance at assistance at any time for any reason. If during the counsel assistance I assistance I feel I need assistance from anyone, either professional or otherwise, I take full responsibility for rejecting the counsel the counsel assistance assistance and and obtaining such professional assistance. ________ Initial SECTION III: INSURANCE DISCLAIMER 11. I understand HISA and Directors do not provide any bond or insurance (neither medical, liability, nor incident) for me during my participation in the counsel the counsel assistance assistance.. Thus, if I want assurance or insurance of any kind, it is my responsibility to obtain such assurance or insurance at my own expense. ________ Initial SECTION IV: IV: RELEASE OF HISA HISA AND DIRECTORS DIRECTORS 13. ASSUMPTION 13. ASSUMPTION OF RISK: I RISK: I am fully aware that participating in the counsel the counsel assistance assistance may may contain risks of legal injury. I know and fully understand the scope, nature and extent of the risks involved in the counsel the counsel assistance and activities contemplated by this Agreement. I voluntarily and freely choose to incur and assume any and all such risks and dangers. ________ Initial 14. EXEMPTION 14. EXEMPTION FROM LIABILITY: I LIABILITY: I hereby fully and forever discharge and release HISA and Directors from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of any damages, both in law and equity, in any way resulting from legal, personal, physical, psychological or emotional injuries, distress, or death arising from or in any way related to the counsel the counsel assistance. assistance. This release from liability includes loss, damage or injury resulting from the negligence of HISA and Directors from any other cause or causes. ________ Initial
P a g e | 5 of 6 15. COVENANT 15. COVENANT NOT TO SUE: I SUE: I agree not to institute, initiate, or assist the prosecution of any suit, claim or action at law or equity, or otherwise against HISA or Directors for damages which I or my heirs, executors, administrators, or assigns hereafter may have arising from or in any way related to the counsel assistance. assistance. This release from liability includes loss, damage, or injury resulting from the negligence of HISA and/or Directors from any other cause or causes. ________ Initial 16. INDEMNITY: 16. INDEMNITY: I I agree to indemnify and hold harmless HISA and Directors from any and all losses, claims, actions, or proceedings of any kind which may be initiated by me and/or any other person or organization on my behalf against HISA and/or Directors. This indemnification includes reimbursement of all legal costs and reasonable “legal” fees incurred by HISA and/or Directors to defend any such actions. ________ Initial 17. WAIVER 17. WAIVER OF PUNITIVE PUNITIVE DAMAGES: DAMAGES : I understand and agree that I am waiving and forever abandoning any claims for punitive or exemplary damages against HISA and/or Directors. I voluntarily choose to give up this Right. ________ Initial 18. RELEASE: 18. RELEASE: In In consideration of HISA and Directors allowing me to participate in the counsel assistance assistance,, I, ____________________ _____________________________ __________________[P _________[Print rint Name], ____________________ _____________________________ __________________[Mar _________[Markk (Signature)] on behalf of myself, my heirs, executors, administrators, administrators, and assigns, hereby RELEASE hereby RELEASE according to provisions to provisions ¶¶ ¶¶ 1 through 17. ________ Initial SECTION V: ARBITRATION ARBITRATION 19. ARBITRATION: 19. ARBITRATION: I I agree that any controversy claim against HISA or Directors not released herein, arising out of or relating to my participation in the counsel the counsel assistance assistance,, shall be settled by private arbitration in accordance with the rules of the American Arbitration Association, and not by lawsuit or resort to court process (except as the law provides for judicial review of arbitration proceedings). This shall apply to all claims including allegations that there have been wrongful acts or omissions by HISA and Directors either intentionally or otherwise. otherwise. The arbitrator’s arbitrator’s decisions may be entered in any court having competent jurisdiction. jurisdiction. By By signing this, I am agreeing that any issue or claim arising out of my participation in the counsel assistance shall be decided by neutral private arbitration. I am giving up my Right to a trial by a Jury or Judge. Judge . ________ Initial SECTION VI: MISCELLANEOUS 20. GOVERNING 20. GOVERNING LAW: I LAW: I understand that this Agreement shall be construed and governed by the laws of the State of California, without the United States (Federal Government) and that it cannot be modified unless in writing and signed by both parties. ________ Initial 21. ENTIRE 21. ENTIRE AGREEMENT: I AGREEMENT: I understand that this Agreement contains all contains all the the promises and agreements between the parties with regard to the release of HISA and Directors and I acknowledge there are no oral or written promises or agreements outside of this Agreement regarding the release of HISA and Directors.
P a g e | 6 of 6 ________ Initial 22. BINDING: 22. BINDING: I I hereby expressly recognize that this Agreement is binding. I have released any and all claims against the indemnified parties resulting from my participation in the counsel the counsel assistance, assistance, including any claims caused by errors, omissions, and/or negligence of the indemnified i ndemnified parties. ________ Initial I HAVE CAREFULLY READ THIS HOLD HARMLESS AGREEMENT AND UNDERSTAND UNDERSTAND ITS CONTENTS. CONTENTS. I CERTIFY THAT I AM 18 YEARS OF AGE OR OLDER, AND SIGN THIS AGREEMENT OF MY OWN FREE WILL. ALL MONEY RECEIVED FROM ME TO HISA IS NON-REFUNDABLE. I RESERVE ALL MY RIGHTS NOT GIVEN UP AND AGREED UPON IN THIS HOLD HARMLESS HARMLESS AGREEMENT. AGREEMENT. I also certify certify agree that; that; I was born within the united States of America boarders; I am currently not wanted for any felony offense by any US Federal Agency and I am not on parole in any State; That I desire to be recognized on my U.S. passport application as a state Citizen as defined in law; I recognize that I am not giving up any status or standing as a Citizen of both your state and of the de jure united States of America (Blacks 6th Def. of United States 3rd Def) ; I AM NOT doing this to avoid prosecution or to get out of paying Federal, State and Local Income taxes. Given [First Name]: __________ _____________________ _____________________ ___________________ __________ _ Surname [Last Name]: ________ ___________________ ____________________ ___________________ _____________ ___ Address: ________________________________________ ____________________ _____________________________ ____________[_______ ___[_______________] ________] Without U.S. Email: ______________________________________ Telephone: ______________________________________ Dated: _______ __________________ ___________ Mark [Signed]: _________ ____________________ ____________________ ___________________ _________________ _______ Revision 5-16-2014
