Let it be known that I, _________________, and my family members, on this day of, ________, __ 2021, in ___(address city state)____ am of sound mind . entitled to freedom from coercion.

This document is addressed to the following persons presented to me in the process of attempting to coerce my (& or my family’s) participation in a harmful to lethal vaccination program:

PRESENTATION TO CITIZEN ON:______________ (Date) __________ (Time)

PROGRAM TITLE (if any):

_________________________________________________________________

AGENCY OR OFFICER:_______________________________________

STATE AGENCY OR OFFICER:_____________________________________

PRIMARY MEDICAL STAFF SECONDARY MEDICAL STAFF

_________________________________ ______________________________

_________________________________ ______________________________

(print name, title / date & request that they initial)

PRIMARY NON-MEDICAL STAFF SECONDARY NON-MEDICAL STAFF

_________________________________ ______________________________

_________________________________ ______________________________

(print name, title / date & request that they initial)

I DO NOT CONSENT to vaccination of myself or my children for the following reasons:

• I know that under current law all physicians and healthcare workers must have my consent to administer medicine and/or vaccination(s) to me. My consent for myself and my family is hereby denied and refused.

• You may not vaccinate me or my children. If you try, I will exercise my right to self-defence against you (and your accomplices) to the extent I deem necessary for the protection of myself and my family.

• Forced vaccination is not authorized or permitted under Law. If there is a code or statutory “mandate” for forced medication, it is unconstitutional, unlawful and unenforceable.

• You may not attempt or threaten non-consensual vaccination, and if you do, you will be dealt with in a manner to restore rule of law, justice and to protect our right to personal physical security and medical autonomy.

• I know that if someone is not a licensed physician, such as a legislator or bureaucrat, they may not administer medicine at all, much less “mandate” medical treatments for the general population.

• Your ignorance of vaccine hazards and medical rights and your inability to understand the facts above do not give you any immunity or any license to commit the crime of forced non-consensual medication.

• I know that, in most cases, it is possible to mitigate and control contagious diseases with safer and more effective means than vaccination.

• Anyone who claims privilege to inject materials in my body without my consent is wrong, is my enemy and is criminal.

• I will treat anyone who threatens to violate my body as a criminal assailant.

• I do not know what is in your vaccine.

• I know that most vaccines have not been tested or proven safe.

• I do not believe your vaccine, or any vaccines produced at this time in history, are tested and proven safe.

• I know that vaccines are so hazardous that the vaccine industry lobbied the US Congress extensively and wrongly received immunity from the harm their vaccines are causing.

• I know that vaccines kill hundreds of thousands of children and adults every year, and the National Vaccine Injury Compensation Fund was created to divert thousands of personal injury lawsuits into a non-judicial taxpayer subsidized system that would produce lower settlements, obstruct access to remedy and cause pharmaceutical companies to have no incentive for safety of their products.

• I know that taxpayers have paid billions of dollars to families who’s members were injured or killed by vaccines through the National Vaccine Injury Compensation Fund and other settlements. To incur such risk must be my choice, not yours.

• I know that many vaccines have been found to contain toxic accelerating adjuvants to shock the immune system, foreign animal and human proteins (DNA), and highly toxic heavy metals.

• I know that toxic contamination is also present in vaccines today, yet could be prevented, which suggests intentional contamination.

• I know that many vaccines are not effective and actually cause the ailment they are purported to mitigate or other auto-immune diseases many years later that would not be present without prior vaccination (numerous credible studies have shown these causal links).

• I know that vaccines contain adjuvants to “shock” the immune system into an extreme response. This causes a biological system “crisis” which includes stress and damage to the immune system, the circulatory system (blood integrity) and the entire body.

• I know that vaccine death and injury statistics and related information are suppressed and censored by transnational corporate-controlled media – which continues to receive billions of dollars in advertising revenue from the pharmaceutical industry year after year.

• I know that vaccine death and injury statistics and information are suppressed by the US government’s regulatory agencies which are demonstrably “captured” and controlled by the pharmaceutical industry. Executive of these agencies are selected by “revolving door” mechanisms controlled by transnational pharmaceutical corporation executives, loyalists and industry lobbyists which has resulted in a highly corrupt industry and regulatory structure.

• I am aware of reports that vaccine experiments have caused millions of cases of polio, sterility, paralysis and other diseases and injuries especially in India, Asia, Africa, the Philippines and many other locations, and that The Gates Foundation (and other related NGO’s) have been banned from India and other nations for the vaccination harms they have perpetrated.

• I do not trust the vaccine industry, government agencies or international agencies which seem to be acting on behalf of vaccine sales and promotion while suppressing information of vaccine hazards and harm.

FEE SCHEDULE: By attempting forcible medical treatments upon me or my children without my consent you are agreeing to pay, at minimum, $500,000.00 penalty per unauthorized injection plus all costs and damages caused by the medical treatment plus all costs of collection.

Your ignorance of vaccine hazards and medical rights and your inability to understand the facts above do not give you any immunity or any license to commit the crime of forced non-consensual medication.

OTHER CONSIDERATIONS FOR MEDICAL AND NON-MEDICAL PROFESSIONALS:

• I have seen no evidence that you know every ingredient of your vaccine.

• I have seen no evidence that you can predict the physical effects of each of those ingredients to any given patient.

• I have seen no evidence that you can predict the consequences of combining those ingredients in an injection.

• I have seen no evidence that you have any authority to administer medicine without the consent of the patient.

• I have seen no evidence that you can assure the safety or effectiveness of your vaccine.

• I have seen no evidence that you will personally take full responsibility to pay for all harm your vaccine causes.

Until you present reliable evidence of the above, you do not have the slightest authority or privilege to forcibly administer vaccines.

If you fail to immediately cease and desist with all threats of vaccination against me and my family, I cannot assure your safety.

SIGNATURE/S: