This statement and the answers contained herein may be used by Applicant, if necessary, in any court of competent jurisdiction.

NOTICE: The undersigned deposes and says that he / she is an officer of the Warwick Shire Council, and is hereby requested to make all required disclosures clearly and conspicuously in writing re the following (please circle applicable answers):

1. Does the Warwick Shire Council advocate Immunization? Yes. No.
2. Does Warwick Shire Council advocate that Immunization (vaccination / inoculation) is 100% safe for babies, children and adults, and will not cause any side effects such as: allergies, sickness, disabilities or premature death whatsoever? Yes. No.
   
   (If you selected ‘No’ to this question, please disregard the following questions, and sign and return this letter. If you answered ‘Yes’ to this question, please answer the following questions, thank you.)
   
3. As you have determined that Immunization is 100% safe for babies, children and adults, by what method did Warwick Shire Council determine this finding? Please explain.
   
4. Does Warwick Shire Council practice medicine? Yes. No.
   
5. Does Warwick Shire Council have a Practitioner’s Licence? Yes. No.
   
6. Does Warwick Shire Council abide by the Therapeutic Goods Act (TGA) in relation to laws pertaining to prescribing medicine to the public? Yes. No.
   
7. As you have determined that Immunization is 100% safe for babies, children and adults, does Warwick Shire Council advertise / inform Warwick Shire Residents of this fact? Yes. No.
   
8. As you have determined that Immunization is 100% safe for babies, children and adults, is Warwick Shire Council confident that the Immunizations contain absolutely no health threat/s to the residents whatsoever? Yes. No.
   
9. As you have determined that Immunization is 100% safe for babies, children and adults, should it later be legally determined that some drugs used in the Immunizations were not / are not suitable for human consumption, for any duration of time whatsoever, and that Warwick Shire Resident’s health had / has been compromised by causing allergies, sickness, disabilities or premature death, what legal measures have been taken to compensate the residents financially for their loss, illness or death? Please explain.
   

Your failure, both intentional and otherwise, in completing / answering points "1" through "9" above (and as per instructions in Q2 above), and returning this DISCLOSURE STATEMENT, as well as providing Applicant with the requisite verification validating your answers to the hereinabove-referenced questions, constitutes Warwick Shire Councils tacit agreement that Warwick Shire Council has no verifiable, lawful, bona fide right to claim that Immunization is suitable for human consumption, and is in fact not suitable for human consumption and optimum health, that Warwick Shire Council tacitly agrees that Warwick Shire Council has a Duty Of Care Obligation to inform all Warwick Shire Residents that Immunization may, or may not be, suitable for human consumption, and that it is the resident’s responsibility to seek medical advice and research whether Immunization is / is not suitable for human consumption, and that by continuing to Immunize themselves - they do so at THEIR OWN RISK, thereby abrogating any legal claims against Warwick Shire Council for prescribing Immunization that is not suitable for human consumption.

Declaration: The Undersigned hereby declares under penalty of perjury of the laws of this State that the statements made in this DISCLOSURE STATEMENT are true and correct in accordance with the Undersigned's best first hand knowledge and belief.

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Date: Printed name of Signatory:

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Official Title of Signatory: Authorized Signature for Warwick Shire Council:

You must timely complete and return this Disclosure Statement, but no later than 5pm on the 6^th June 2003, along with all required documents referenced in said DISCLOSURE STATEMENT. After the 6^th June 2003, should the Warwick Shire Council ever be prosecuted for willfully and knowingly prescribing Immunization unfit for human consumption, Immunization that has been proven to cause allergies, sickness, disabilities or premature death, the Warwick Shire Council shall in no wise be exempt from any liability whatsoever, due to the fact that this matter has been brought to the Warwick Shire Council’s attention. Any claims for exemption and immunity from any resultant lawsuits will not be considered if any portion of this Disclosure Statement is not completed as required and timely returned with all required documents. If Warwick Shire Council does not respond as required by law, it shall be taken that Warwick Shire Council gives full consent to being liable for any allergies, sickness, disabilities or premature death or misfortune caused to Warwick Shire Residents by accepting Warwick Shire Council’s recommendation of Immunizing, in the event that the Immunization is proven to be unfit for human consumption.

Modified Tuesday, January 18, 2011