WORLD PRESIDENTIAL BALLOT

DISTRIBUTED BY
The World Government House
POB 9390
South Burlington, VT  05407
USA

"The will of the people shall be the basis of the authority of government; this will shall be expressed in periodic and genuine elections which shall be by universal and equal suffrage and shall be held by secret vote or by equivalent free voting procedures."

As a registered Citizen of the World, I hereby fulfill my fundamental world civic right and duty outlined above by voting for a World President to represent me in all matters of common concern for the General Good and the Good of All as defined by the Universal Declaration of Human Rights.

I hereby vote for ________________________________ as World President to represent me as a Citizen of the World.   This vote is without prejudice to and in no way affects my status, national or otherwise.

Signature _____________________________________________________________

Name _______________________________________________________________

Address ____________________________________________________________

City __________________________________________________

State __________________________ Postal Code _____________

Country ____________________________________________________

World Citizen Registration Number _________________________________

                                         AFFIDAVIT

NATION __________________________ STATE _________________________ CITY _________________

On this __________ day of ______________ , ______ , before me personally came _________

__________________________________________________ to me known and known by me to be the

person who executed the foregoing form and he/she thereupon duly acknowledged to me that he/she

executed the same.

Notary ______________________________________________________________________________

Contributions to
World Government House
Merchant Bank, South Burlington, VT 05403
Account Number #3383510