Friend #1 Email Address:
Friend #1 Phone Number:
Friend #2 Email Address:
Friend #2 Phone Number:
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1. I CERTIFY I have lawful authority over a MINOR PSPD individual, AS FOLLOWS:
(A)ttorney, by the Parent/Guardian/Conservator
2. OR I CERTIFY I have the following Legal Relationship to, or Authority over an ADULT PSPD, AS FOLLOWS:
I am Legal (P)arent of a PSPD, but with NO Legal Authority
I am Legal (G)uardian of a PSPD
I am Legal (C)onservator of a PSPD
I am Paid (C)aregiver of a PSPD
I am the (A)ttorney of a PSPD
Please confirm that you I understand and agree that if aH4L! confirms you are a "NON-CITIZEN", your Registration and/or Membership will be voided upon our Notice.
i. They have an IQ greater than (>) 60
ii. They are of "Normal" Emotional Behavior, which I confirm, ALL the below are true:
a) They are NOT affected by any Behavioral Disease, Disorder, and/or Psychosis,
b) They DO NOT have, NOR have they ever had a diagnosis as in a) above, by a Physician or Psychologist,
c) They are NOT avoiding Assessment or Treatment, or self-treating for any items listed in a) above
They are "financially independent" - meaning, they provide for themselves, or with government assistance, and
no other person or Trust or Organization provides for them financially as "DEPENDENT" or "Beneficiary".
On US or State tax returns (US 1040x), they DID/COULD claim "YOURSELF" as correct "Filing Status" (Line6a).
Their Income is less than thirteen thousand dollars (<$13,000) if their tax-status above, is SINGLE (Line1),
OR is less than than twenty-six thousand dollars (<$26,000) if their tax-status above is MARRIED (Line2 or 3)
Their Net Worth is less than two thousand dollars (<$2,000) if their tax-status above is SINGLE,
OR is less than four thousand dollars (<$4,000) if their tax-status above is MARRIED
They are NOT NAMED as Beneficiary on any Trust, "Special Needs" or "Other", "Revocable" or "Irrevocable",
valued at more than seventy-one hundred dollars (>$7,100), the median (2012) US cost of a Funeral.
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