STATUTORY DECLARATION

 

I, Damian Arntzen of ................................................................................................................ in the State of Western Australia do solemnly and sincerely declare that the facts contained in the attached deed are, to the best of my knowledge and belief, true and correct in every particular.

 

And I make this solem declaration conscientiously believing the same to be true, and by virtue of the provisions of the Evidence Act, 1906.

 

 

 

Declared at Perth )

On this ....... Day of September 2002 )

Before me: ) ___________________________________

 

 

 

 

________________________

Justice of the Peace/Commissioner for Declarations

 

DEED OF RELEASE

THIS DEED is made by Damian Arntzen of ......................................................... In the State of Western Australia.

Acknowledgements

    1. I have pursued the Scientology religion voluntarily, and have been a member of the Church of Scientology of my own volition.
    2. I am familiar with the Creed of the Church of Scientology and the policies of the Church as written by its Founder L. Ron Hubbard and have adopted these as the guiding principles of my life.
    3. I am fully aware that Scientology is a religion. I have received some spiritual counselling (called auditing, the religionís core practice) as well as confessional counselling and training in the theology, policy and ethics of the Scientology Religion. I have had increased spiritual awareness from these activities and I am fully satisfied with the results.
    4. I have not been harmed in any manner or form by any experiences as a parishioner of any Church of Scientology or through my involvement with Scientology Religious technology or Dianetics Spiritual Healing technology or with any authorized organisations using such technologies.
    5. I acknowledge that the Church and its associates have not made any statement, representation or promise to myself regarding any fact or matter material to this Release except as it is herein expressly stated.
    6. I understand and agree that in order for me to receive further religious and spiritual counselling, I need to release and indemnify and discharge the Churches of Scientology, their staff, officers, Board of Directors, religious workers, employers, agents, representatives, parishioners, affiliated organisations and entities, L. Ron Hubbardís heirs, successors and assigns, and the Authorís Family Trust (Ďreleasesí), from liability for my actions.
    7. I am not under the influence of any drugs, narcotic, alcohol or mind-influencing substance, condition or ailment such that my ability to fully understand the meaning of this release is adversely affected.
    8. I acknowledge the Church has offered to assist in recommending independent legal counsel to advise me further on this matter. I have freely chosen to forgo such an opportunity and to enter into this deed of release and waiver of my rights without such advice. I have read and fully understand the nature and content of this document, including the significance of waiving any actual or potential claim I may have, and sign it below voluntarily and without any threat or duress.
    9. ________________ ________________

      Agreement

      1. I do not hold any Church of Scientology responsible in any manner or form for any of my actions and fully understand and state to be true that my actions are my own personal responsibility.
      2. I agree to keep confidential and not disclose any knowledge, information or material acquired by myself directly or indirectly concerning the Church or any of its associates and, without limiting the foregoing, shall not directly or indirectly publish or assist another to publish or assist another to publish any such knowledge, information or material whether in the form of books, magazines, periodicals, newspapers, articles or other literature or in the form of film, video, audio tape, television or in any other form of media.
      3. I have no desire or intention to testify or otherwise participate in any judicial administrative or legislative proceedings adverse to Scientology or the Church or any of its associates unless compelled to do so by lawful process. I therefore agree not to do so and I state quite clearly here that I have no wish, desire or intention to attack, harm or in any way malign the Church of Scientology.
      4. I hereby disclaim and waive all rights to any potential claim that I may have had at any time, present or future, to any such refund of monies donated to the Church or any of its servants or agents and undertake not to at any time instigate or pursue any other claim or to go to the media or other authorities on the same matter.
      5. I hereby release and forever discharge and agree to indemnify the releases, from and against all actions, costs, claims and demands which may be made against them arising out of any act of mine.
      6. In the event that any portion of this release is found to be legally unenforceable, this shall not affect the binding nature of the remainder of the release which shall remain in full force and effect, nor shall it effect the truthfulness of the statements I have made in this Deed.

IN WITNESS WHEREOF the parties have executed this Deed on this ......... Day of .......... 2002.

 

SIGNED SEALED AND )

DELIVERED BY )

DAMIAN ARNTZEN ) _________________________

IN THE PRESENCE OF )

________________________

Justice of the Peace/Commissioner for Declarations