Professional Documents
Culture Documents
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P.O. Box ll2l92
Cincinnafi , Ahto 45211-2192
February 28e2018
ACCOUNT CONTROL TECHNOLOGY rNC. (ACT)
21700 Oxnard Ste6t Suite 1400
Dept. 115507379-DN01
Woodland Hills, CA 91367
Jurat
3?"8'26.58'N.Lati8{."33' 29014"W,Long: Sha}vnee/Ohio: Atlan/ Iurtle Island
United Nations Declaration on the Rights of Indigenous
(http ://www.un. org/esa/socdev/unpfi l/documents/DRlP S-en.pdfl
UN Convention on Economic, Social & Cultural Rights, and United Nations Charter: Article 55 & 56:
Presidential Proclamation 7500, H.J.R. 194, S. Con. Res 26.5.1200.
:Nanya-Faatuh :El@@ru Authorized representative for Kintya Lamar Thomas@Oru Indigenous Autochthonous
Secured Party File No.16-A3-25-5215-1, UCC $3-402 (b) - O.RC. $1303.42 ; UCC $1-103 -
O.R.C.$1303.103; UCC $1-308 - O.R.C. $1303.308 AU Rights Reserved.
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Notary Public My CommissionExpires
lt*t$ *fl!l$M$ Ts ALL,
Name (Last, First, Middle lnitial) Social Security Number Birthdate (Month and Year)
Ethnicity and race information is requested under the authority of 42 U.S.C. Section 2000e-16 and in compliance with
the Office of Management and Budget's 1997 Revisions to the Standards for the Classification of Federal Data on Race
and Ethnicity. Providing this information is voluntary and has no impact on your employment status, but in the instance
of missing information, your employing agency will attempt to identify your race and ethnicity by visual observation.
This information is used as necessary to plan for equal employment opportunity throughout the Federal government. lt
is also used by the U. S. Office of Personnel Management or employing agency maintaining the records to locate
individuals for personnel research or survey response and in the production of summary descriptive statistics and
analytical studies in support of the function for which the records are collected and maintained, or for related workforce
studies.
Social Security Number (SSN) is requested under the authority of Executive Order 9397, which requires SSN be used
for the purpose of uniform, orderly administration of personnel records. Providing this information is voluntary and failure
to do so will have no effect on your employment status. lf SSN is not provided, however, other agency sources may be
used to obtain it.
Specific lnstructions: The two questions below are designed to identify your ethnicity and race. Regardless of your answer to
question 1, go to question 2.
Question 1. Are You Hispanic or Latino? (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other
Spanish culture or origin, regardless of race.)
C Yes Eil Itto
Question 2. Please select the racial category or categories with which you most closely identify by placing an "X" in the appropriate
box. Check as many as apply.
RACIAL CATEGORY
DEFINITION OF CATEGORY
(Check as many as apply)
E American lndian or Alaska Native A person having origins in any of the original peoples of North and South America
(including Central America), and who maintains tribal affiliation or community
attachment.
tl Asian A person having origins in any ol the original peoples of the Far East, Southeast
Asia, or the Indian subcontinent including, for example, Cambodia, China, India,
Japan, Korea, Malaysia, Pakistan, the Philippine lslands, Thailand, and Vietnam.
ff Black or African American A person having origins in any of the black racial groups of Africa.
ff Native Hawaiian or Other Pacific lslander A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or
other Pacific lslands.
f, wnite A person having origins in any of the original peoples of Europe, the Middle East, or
North Africa.
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PAGE(S) 13
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I r('r'rltd'rl l n' r'inr l er rt, t'rrcixrn, I.rn r cltir rpr, discr rh'at rcl risctnetrt,
llltrrh ('txlrs, atrd t'ttcinl scgrcgatiotr larrs tlrtrt irnposutl rt
rigitl slstcrtt of offlrriall.v sattt:tiorrcd racittl scgtcgtttitttr irr
virtnall.r' nll itt'ttts of lift;
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\\'lrcretrs tlxr s,rxtun of tlrr juru rat:itrl segregrtiotr knrlnn trs
"Jirn ('r'rnl'", rrhitrlt ar'()r.ir] itr certain parts of thc lirritcd
Stirtcs aftt.r' tlrc (livjl \Var to crcate separate and urrcqual
socit,tics firr' \\rlrites arrcl Africau-Americans, rvas a clirect
resrrlt of tlrc raeisln appdnst per4lle of Afi{ean dcscent
thttt rrrrs ctrgerrdct'qd ll.v slavery;
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\Yhertns the s.rxtcnr of .Jirn Crurr laws officially existr:d urrtil
thc I flti0s-rr rcrrturl, after the offroial end of slavery in
thc Unitctl Strrtes-urrtil Coirgress ttxrh aetion to urd it,
lltrt tht' r,tstig:s of Jirn Cxtrv contfirue to this clay;
\Ylrtrycas ,\f ictrrr-l\rnericau$ trontinue to suffer from the corr-
of slurtlr-r' artd ,Iim Oror,v larvs-long after botlr
sc(lurru{:r,rJ
svst(.rrlri \\'()r'c fix'rnall.t, abolisheel-tlrrough enormous
rlarnagc trrrd loss, both tangible and intangible, including
tlte losr* of lttrurrttr tligrrit.l' ancl liberty;
\{hertrrs the strlry of thc crrslarement and de jure scgregation
of Afi{ctrrr-Arncricaus and the clehumanizing a.troeities
t:ornnrittrtl ergerirrst thcrn should not be purged from or
nrirrinriztd in tlrt' tcllirrg of the history of the llnited
Sttrt"r's;
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aud thc larvs of the {Initetl $hrtes, to luaht' a f'ot.rnal
nlxrlogy fitt' slnvtrw arrd firr its sllc(:orJsor, Jjrrr ('r'r)r\', sr)
th(rv rarr rllo\re fbnvard rurtl scek rccrlrrcilirrtiorr, jrrstirtr,
rrrrd hirrnorr.v firr all ptr4rlcr of tlrc Ulritctl Stirtcs: Not',
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CINi]It'lNATI
0H 45238
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L.orat CVtjli0
[evice ID: -BT[02
TransaL:tion: 910'191512844
FedEx firound
771691474164 0,e lbs. (S) 1ir.48
lleclarerl Value 100