Form 1026-2001 - United States Citizen Consent Form And Survey printable pdf download

Form 1026-2001 - United States Citizen Consent Form And Survey

Form 1026-2001

United States Citizen Consent Form and Survey

Must Be Filled Out by All Citizens and Sent to Dept of Homeland Security

1. The United State Government may listen in on all my phone calls, it may

secretly review all my mail and email, and it may seize any other information

about me using any means. Yes ____ No ____

[Note: by failing to check “yes,” you will have given the U.S. Government probable cause to spy on

you, to include all of your phone calls, mail, email and any other information about you.]

2. I relinquish all expectation of participating in the U.S. Government as a

concerned citizen. Henceforth, I ask the U.S. Government to consider the

large corporations who give money to Congressional candidates to be my

proxies.

Yes ____ No ____

3. My position is that “government is the problem” and that we should

therefore defund all federal programs except for our vast war machine.

Yes ____ No ____

4. I insist that the United States continue to rely heavily on petroleum, coal

and other fossil fuels. I am also in favor of a law prohibiting anyone from

suggesting that our current energy policy is unsustainable or dangerous to

Americans. Yes ____ No ____

5. The “invisible hand” and the “free market” will take care of everything. All

people need to do is live locally and everything will take care of itself.

Yes ____ No ____

6. Terrorists from the Middle East are America's biggest problem, along with

gays who get married and people who don’t go to church. Yes ____ No ____

7. Please describe in detail where you keep all of your important information

(Internet storage cloud, email services, safety deposit boxes, file cabinets,

locations of backup hard drives). Attach separate sheets to provide a highly

detailed answer:

__________________________________________

Your Name

Date

Erich Vieth 2011

Form 1026-2001 - United States Citizen Consent Form And Survey