Ensure Privacy. Downloadable PUBLIC SERVANT’S QUESTIONNAIRE – Public Law 93-579

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Please use downloadable format for any time you believe your privacy is being violated. If the person/agent signs, it demonstrates good faith that the said person/agent does not intend to violate our rights. Thanking all officers of law, who “protect and defend our constitutional rights”

Download Public Servant Questionnaire in PDF (click here)

Now we all must Celebrate Sodomy Marriages (a form of worship) in the Holy Sanctuaries of our churches, or be charged with HATE CRIMES and be imprisoned just like Jesus and all the Saints before us.

Now any priests who refuse to give a “marriage” between two men at the prominent place of their holy sanctuary (even if before only virgins were allowed to marry at that portion of the sanctuary), then such priests will go to jail. Lawsuits have been filed in all 50 states against the churches and priests who have faith that God and nature is correct. Now renegade public servants have decided that sodomites, trangenders and lesbians must be celebrated and taught as good to all children within the walls of any church the said wicked promoters so choose to have it held. Now domestic insurrection against our rights is being waged not only by private individuals, but by the renegade public servants themselves. Now in the US, if any church says they believe marriage is between a man and a woman then the priests will go to jail, and the said church is destroyed. I suggest everyone have such questionnaires to ensure our fundamental rights to freedom of association and disassociation is respected by such agents.
Remember, there will be no lukewarm in the end times, no on the fence. Just light vs darkness. This was foretold clearly in Revelation that such abominations will be exalted above everything of God, and to be worshipped in our very holy places (to exalt ABOMINATIONS with much love from the heart ie GAYNESS) rather than delighting in God’s commandments with all the heart, like David did. The agents of Satan won’t rest until all civilization (Christian civilization) is destroyed. Call on your neighbours, family, friends and community to prepare as if for Armageddon.


This questionnaire was written by Daniel J.  Schultz.  Daniel is a graduate of the United States Military Academy at West Point, New York and a practicing attorney in Los Angeles, California.  He is the President, and a co-founding member of “The Lawyer’s Second Amendment Society” (LSAS), a nationwide network of pro-right to keep and bear arms attorneys.


Title 5 of U.S. Code Annotated 552(a)

Public Law 93-579

Public Law 93-579 states in part: “The purpose of this Act is to provide certain safeguards for an individual against invasion of personal privacy requiring Federal agencies…  to permit an individual to determine what records pertaining to him are collected, maintained, used or disseminated by such agencies….”

The following questions are based upon that act and are necessary for this

individual to make a reasonable determination concerning divulgence of

information to this agency.


  1. Name of public servant ___________________________________________


  1. Residence address ______________________________________________


City ______________________________ State _________ Zip __________


  1. Name of department of government, bureau, or agency by which public

servant is employed



Supervisor¹s name ______________________________________________


  1. It’s office mailing address:_________________________________________


City _______________________________ State _________ Zip _________


  1. Will public servant uphold the Constitution of the United States of America?


Yes ______ No _______


  1. Did public servant furnish proof of identity? Yes_______No _______


  1. What was the nature of proof?


ID No.  _____________________


Badge No.  _________________


Driver¹s License No.  ____________


  1. Will public servant furnish a copy of the law or regulation which authorizes this

investigation?                                                  Yes _______ No __________


  1. Will the public servant read aloud that portion of the law authorizing

the questions he will ask?

Yes __________ No _________


  1. Are the citizen’s answers voluntary? _____ Or Mandatory?  ____


  1. Are the questions to be asked based upon a specific law or regulation?

Yes __________ No _________


Are they being used as a discovery process?

Yes __________ No _________


  1. What other uses may be made of this information?






  1. What other agencies may have access to this information?






  1. What will be the effect upon me if I should choose to not answer any part of

these questions?








  1. Name of person in government requesting that this investigation be made?





  1. Is this investigation “general?” ______ or is it “special?” ________


Note: By “general” is meant any kind of blanket investigation in which a

number of persons are involved because of geography, type of business,

sex, religion, race, schooling, income, etc.

By “special” is meant any investigation of an individual nature in which

others are not involved.


  1. Have you consulted, questioned, interviewed, or received information

from any third party relative to this investigation?  Yes ______ No _____


  1. If yes, the identity of all such third parties?






  1. Do you reasonably anticipate either a civil or criminal action to be initiated or

pursued based upon any of the information which you seek?


Yes ________ No _________


  1. Is there a file of records, information, or correspondence relating to

me being maintained by this agency?       Yes ________ No __________


  1. Is this agency using any information pertaining to me which was supplied by

another agency or government source?


Yes ________ No ________


If yes, which agencies and/or sources?  _____________________________


  1. Will the public servant guarantee that the information in these files will not be

used by any other department other than the one by whom he is employed?


Yes __________No _________




AFFIRMATION BY PUBLIC SERVANT I swear (or affirm) that the answers I have given to the foregoing questions are complete and correct in every particular.




(Must be signed in ink.  This signature should be witnessed by two people.  Citizen may administer an oath if he or she so desires.)



Witness _______________________________________________________


Name Printed __________________________________________________



Witness _______________________________________________________


Name Printed ___________________________________________________


Authorities for Questions:

1,2,3,4   In order to be sure you know exactly who you are giving the

information to. Residence and business addresses are needed in case you

need to serve process in a civil or criminal action upon this individual.

5                               All public servants have taken a sworn oath to uphold and

defend the constitution.

6,7            This is standard procedure by government agents and officers.

See Internal Revenue Manual, MT-9900-26, Section 242.133.


8,9,10       Title 5 USC 552a, paragraph (e) (3) (A)

11                            Title 5 USC 552a, paragraph (d) (5), (e) (1)

12,13        Title 5 USC 552a, paragraph (e) (3) (B), (e) (3) (C)

14                             Title 5 USC 552a, paragraph (e) (3) (D)

15                             Public Law 93-579 (b) (1)

16                             Title 5 USC 552a, paragraph (e) (3) (A)

17,18        Title 5 USC 552a, paragraph (e) (2)

19                             Title 5 USC 552a, paragraph (d) (5)

20,21        Public Law 93-579 (b) (1)

21             Title 5 USC 552a, paragraph (d) (1)

22                             Title 5 USC 552a, paragraph (e) (10)



If any request for information relating to me is received from any person or agency, you must advise me in writing before releasing such information. Subcontractors of US agencies are not immune to such prosecution. Filling it in completely shows good intent, that such agents or officials are not domestic or foreign “Enemies of the Constitution”. I prefer to trust and honor those who follow the laws cited herein, as evidence of their good intent.  Failure complete the form subjects such agents to possible civil or criminal action pursuant to the Privacy Act, Public Law and the US codes cited herein.



Thanking all officers of law, who “protect and defend our constitutional rights”

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