Updated 04/09/05

Notice of Surrender, Rescission, and

Termination of Fiduciary Responsibility
Instructions
This is the first and only notice you send to the banks. If you still have
the credit cards, return them with the notice. If you do not have the
credit cards, don't worry about it.

Postage Information:
Certified Mail Receipt Number:
This is important. This notice must be mailed certified. This gives you
proof of mailing.
You can pick up the Certified Mail Receipts at the post office. Get a
stack.
Each Certified Mail Receipt has a unique number. Enter that number in
this space.

Bank Information:
Name of Bank:
The first thing you need is the name of the bank that issued the credit
card. It should appear on your statement.
Name of Bank Officer:
If you still have a copy of the agreement the bank sent you with your
credit card it should have the name of an officer at the very end. If not,
call customer service, the number will be on your statement, and ask
for the name of a bank officer. If nothing else, ask for the phone
number of the banks headquarters. Then call that number and get the
name of the CEO. Look at the bank's website. Look on the forum. There
are information resources available you can use.
You cannot use just any old name. An employee, manager, or
supervisor will not do. It must be an officer, Vice President, President,
CEO, Chairman of the Board, etc.
If you cannot find this information, or you just don't care to try, leave it
blank.

Mailing Address:
This is not the address you mail your payments to. It is the address for
payment disputes. It should be shown on your statement. It may also
be called "customer service." Do Not mail the NOS to the
corporate headquarters.
Credit Card type:
Visa, MasterCard, Discover, etc.
Card number:
I think you can figure this out for yourself.

Your Information
Full Name
Enter your name exactly as it appears on the statement.
Address, City, State:
Enter the address where you want your correspondence sent. Make
sure you spell out the name of your state. This is important. It is used
in the Notary section and must be spelled out.
Notarization
This document must be notarized. So, don't sign it until you are in front
of the Notary.
You can find notaries at most insurance agencies and banks. AAA also
has notaries in their offices. Look in the yellow pages.

Filing
This document need not be filed with the County Recorder/Clerk.

Mailing
Once the document is notarized, have a copy made. You mail only the
copy. Keep the original for your records. Do this with all the documents
in this process.

Department of the Treasury, Internal Revenue Service,

Form 56
This form is referenced in the NOS. A copy must accompany the NOS.
This form must be completed separately.
See separate instructions under Form 56 on how to complete this form.
The actual document starts below:
Certified Mail Receipt Number: Receipt Number

NOTICE OF SURRENDER, RESCISSION, AND

TERMINATION OF FIDUCIARY RESPONSIBILITY
Reference: Account Number: Credit Card Account Number
To:

Bank Officer Name

Bank Name
Bank Address
Bank Address 2
Bank City, State Zip
Pursuant to the Federal Rules of Evidence 201 (d) and the
corresponding state rule please take notice the following facts:
1. Declaration of Independence.
2. Constitution for the United States of America
3. Yick Wo v. Hopkins, 118 US 356, 370.
4. The undersigned rescinds any signatures associated with the above
referenced account.
5. The undersigned surrenders the agreement, credit card, and account
between Bank Name and the fiction ALL CAPS NAME ON
STATEMENT back to their creators and rightful owners.
Surrender: To give back; yield; render up; restore;
Black's Law Dictionary, Sixth Edition, pg. 1444.
6. (Bank Name) has nothing at risk and has not lent Your Name
Here in upper and lower case) or ALL CAPS NAME SHOWN ON
BANK STATEMENT) any of its money. The alleged account was funded
by (Your Name Here in upper and lower case)'s application. See
Federal Reserve Bank of Chicago's publication "Modern Money
Mechanic."
at page 6: "What they do when they make loans is
to accept promissory notes in exchange for credits

to the borrower's transaction accounts. Loans

(assets) and deposits (liabilities) both rise by
$9,000. Reserves are unchanged by the loan
transactions. but the deposit credits constitute new
additions to the total deposits of the banking
system."
at page 7: "Loans are made by crediting the
borrower's deposit account, i.e., by creating
additional deposit money."
7. Your Names in Upper and Lower Case no longer accept any
fiduciary responsibility for the fiction ALL CAPS NAME ON
STATEMENT in the instant accounts. Please see the attached Form 56.
8. Any further contact by Bank Name or any of its agents with Your
Names In Upper and Lower Case will be considered harassment
and attempted extortion through violence. These threats will be dealt
with in an appropriate manner.

Affidavit
State of Your State }
} ss:
County of Your County}
I/We, Your Name and Spouse's Name, hereafter I/We, am/our
competent to testify by first hand knowledge do hereby affirm that:
I/We live at Your Address (leave out zip code).
I, Your Name, am a man.
I, Your Spouse's Name, am a woman.
I/We have never represented ourselves using an all caps name.
I/We surrender back to their creators and rightful owner, (Bank
Name) the (Name of Credit Card) its account and agreement.
I/We no longer accept any fiduciary responsibility for the above
referenced credit card, account or agreement.
The attached copy of Form 56 is true and accurate.
Further affiant saith naught.
I/We, Your Name(s), knowing the penalty of bearing false witness,
hereby affirm the foregoing to be true and correct to the best of
my/our knowledge and belief and do affix my/our signature in
testimony of the foregoing notice.
EXECUTED THIS ______ day of Month, Year
________________________ and ______________
Your Name and Spouse's Name,

Your Address
Your City, State Zip
Signatory, Your Name and Your Spouse's Name , personally
appeared before me and is/are known to me and did affix his and her
signature to this document. In witness thereof I set my hand and seal
_____________________________________________
Notary Public in and for the State of Your State.
My commission expires: