State of
) ss.
I am over 18 years of age and not a party to
the within action; my mailing location is:
c/o
Post Office Box 373
Loma
Linda [CA 92354]
On this _______ Day of _______________ in the
Year of our Lord two thousand Two I served the following:
·
Confirmed Actual and Constructive Notice, one Conforming
Copy, two
(2) pages;
and California Notary Acknowledgment, one Certified Copy, one
(1) page, a total of three (3) pages; and,
·
Bill of Exchange, one Conforming Copy, two
(2) pages;
with
Attachments:
·
[CHILD’S FIRST NAME: Gunnar, MIDDLE NAME: Anders,
and LAST NAME: Smars, Jr.:] STATE OF
·
LAURIE ANN HIRSSIG: OHIO DEPARTMENT OF HEALTH
CERTIFICATE OF LIVE BIRTH, one Certified Copy, two (2) pages;
·
HANS ANDERS NORWYN SMARS: FORM DS-1350, UNITED
STATES OF AMERICA DEPARTMENT OF STATE Certification of Report of Birth of a
United States Citizen #159-1086442-1, one (1) page; FORM FS-240, UNITED STATES
OF AMERICA DEPARTMENT OF STATE Consular Report of Birth Abroad of a Citizen of
the United States of America #159-1086442-1, Certified Copy, two (2) pages;
FORM FS-240, DEPARTMENT OF STATE REPORT OF BIRTH ABROAD OF A CITIZEN OF THE
UNITED STATES OF AMERICA, Certified Copy, two (2) pages; Form FS-545,
DEPARTMENT OF STATE FOREIGN SERVICE OF THE UNITED STATES OF AMERICA Certification
of Birth Abroad of a Citizen of the United States of America, Certified copy,
one (1) page; a total of six (6) pages;
·
JONATHAN OLIVER NOAH SMARS: FORM DS-1350, UNITED
STATES OF AMERICA DEPARTMENT OF STATE Certification of Report of Birth of a
United States Citizen #159-1086441-1, one (1) page; FORM FS-240, UNITED STATES
OF AMERICA DEPARTMENT OF STATE Consular Report of Birth Abroad of a Citizen of
the United States of America #159-1086441-1, Certified Copy, two (2) pages;
FORM FS-240, DEPARTMENT OF STATE REPORT OF BIRTH ABROAD OF A CITIZEN OF THE
UNITED STATES OF AMERICA, Certified Copy, two (2) pages; Form FS-545,
DEPARTMENT OF STATE FOREIGN SERVICE OF THE UNITED STATES OF AMERICA
Certification of Birth Abroad of a Citizen of the United States of America,
Certified copy, one (1) page; a total of six (6) pages;
·
KRISTALINA ANN-LOUISE AMITA SMARS: FORM DS-1350,
UNITED STATES OF AMERICA DEPARTMENT OF STATE Certification of Report of Birth
of a United States Citizen #159-0055966, one (1) page; FORM FS-240, UNITED
STATES OF AMERICA DEPARTMENT OF STATE Consular Report of Birth Abroad of a
Citizen of the United States of America #159-0055966-1, Certified Copy, two (2)
pages; FORM FS-240, UNITED STATES OF AMERICA DEPARTMENT OF STATE Consular
Report of Birth Abroad of a Citizen of the United States of America
#159-0055966, Certified Copy, two (2) pages; a total of five (5) pages; and,
·
GUNNAR A SMARS JR 550-27-7015: SOCIAL SECURITY card,
Certified Copy, one (1) page;
A total of twenty-six (26) pages, plus a Form 1040-ES
to be completed by the Respondent, including, but not limited by, all
attachments (not including this
Affidavit of Service), are being served by this United States Postal
Service Registered Mail #RA 029 924 850 US, in a sealed envelope with
postage pre-paid, properly addressed to the Secretary of the Treasury as follows:
Paul H. O’Neill
Secretary of the Treasury
Department of the Treasury
I declare under penalty of perjury under the
laws of the state of California that the above is true, correct, and complete,
and that this Affidavit of Service was executed on Tuesday the Twenty-ninth Day
of January in the Year of our Lord two thousand Two at Loma Linda, California.
__________________________________
State of
) ss.
On this ______ Day of
___________ in the Year of our Lord ________ before me, Lillian V. Miller,
Notary Public, appeared
WITNESS my hand and official
seal.
____________________________________
Signature of Lillian V.
Miller, Notary Public
