Source: https://www.taxhonestyprimer.com/2010/02/affidavit-of-material-facts.html
Timestamp: 2019-04-25 06:28:36+00:00

Document:
This affidavit of material facts sets forth fact statements concerning my status and relationship to internal revenue laws of the United States and acts and omissions by Internal Revenue Service personnel that have adversely affected and are adversely affecting my substantive and procedural rights of due process as well as my inalienable rights.
The controversy involves alleged federal income tax liabilities for calendar year(s) , , and . This affidavit is sworn and subscribed before a duly commissioned state notary public and therefore qualifies as testimony in all jurisdictions under the full faith and credit clause of the Constitution of the United States.
1. My name is (NAME) ; I am a living, moral being endowed with unalienable rights to life, liberty and property, and all substantive rights secured by the Constitution of the United States and the Constitution of the State of (STATE).
2. I am a Citizen of (STATE) , which is a State of the Union.
3. My abode and dwelling is geographically located in (STATE), which is a State of the Union.
4. I do not have a foreign tax home as defined in the Internal Revenue Code and am not subject to the Commissioner of Internal Revenue’s authority delegated by Treasury Order 150-17 relating to foreign exchange of tax information.
10. IRS examination and/or appeals officers have never provided me with findings of fact and conclusions of law that comply with requirements of 5 U.S.C. §§556(d) & (e).
11. IRS personnel have never affirmatively established IRS standing and venue jurisdiction in (STATE) on the record with documentary or testimonial evidence.
12. In the calendar year or years specified above, to the best of my knowledge, all of my income, regardless of nature or the activity from which it was derived, was from sources in (STATE) and/or other States of the Union.
13. In the calendar year or years specified above, to the best of my knowledge, all of my earnings and other forms of income were from private enterprise in (STATE) and/or other States of the Union.
17. In the calendar year or years specified above I was not a person required to deduct and withhold a tax pursuant to 26 USC §1441.
18. In the calendar year or years specified above I was not a person “made liable for such tax” as specified at 26 USC §1461.
19. I am not a resident alien lawfully admitted to a State of the Union, the District of Columbia, or an insular possession of the United States.
23. I am not a person subject to Internal Revenue Service tax audit and/or check authorized by Treasury Order 150-29.
24. In the calendar years specified above, I did not receive notice from the Secretary of Health and Human Services that I received or paid wages, as required by 42 U.S.C. 405(3), (4)(A), (4)(B).
25. I am not subject to and do not participate in the Northern Mariana Islands Social Security Tax administered by the Internal Revenue Service under authority of Treasury Order 159-18.
27. I am not an officer or employee of the Treasury or any bureau of the Department of the Treasury subject to Internal Revenue Service authority related to submission of collected taxes delegated by Treasury Order 150-15.
28. In the calendar year or years specified above, to the best of my knowledge, I did not receive items of taxable income from foreign sources (26 CFR § 1.861-8(f)(1)(vi)(A)).
29. In the calendar year or years specified above, to the best of my knowledge, I did not receive foreign mineral income (26 CFR §1.861-8(f)(1)(vi)(B)).
30. In the calendar year or years specified above, to the best of my knowledge, I did not receive income from foreign oil and gas extraction (26 CFR §1.861-8(f)(1)(vi)(D)).
43. In the calendar year or years specified above, to the best of my knowledge, I did not receive any items of income from activities taking place within an “internal revenue district” as such districts have been established under authority of 26 USC 7621.
45. To the best of my knowledge, I have never been involved in activity involving controlled substances subject to Internal Revenue Service investigation under authority of Treasury Directive 15-42. (See 26 CFR §403)In the calendar year or years specified above, to the best of my knowledge, I did not receive items of income from production and/or distribution of opium, cocaine or other controlled substances in the District of Columbia or insular possessions of the United States.
46. In the calendar year or years specified above, I did not knowingly and intentionally contribute or contract to contribute money, property, or other assets to the Treasury of the United States.
47. In the calendar year or years specified above, to the best of my knowledge I did not engage in any activity regulated under authority of Title 27 of the United States Code.
I attest and affirm that I have personal knowledge of all the facts stated in this Affidavit, and that they are true and correct and that they are provided under penalties of perjury under the laws of the State of (STATE), so help me God.
On this date before me personally appeared (NAME) who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the above instrument and acknowledged to me that (s)he executed the same in (his/her) authorized capacity and that by (his/her) signature on the instrument, executed the instrument.
Witness my hand and official seal, this _________day of ________________, 2010.

References: §1441
 §1461
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