Acknowledgement, Acceptance and Deed of Re-Conveyance
I, the living man, John Mark Doe, being of age, of sound mind and in good health, free of all duress or improper consideration hereby acknowledge, accept, and re-convey my given lawful Trade Name, John Mark Doe to the land and soil of Wisconsin, my native state, together with all derivative names, including John Doe, John M. Doe, J.M. Doe, JOHN MARK DOE, JOHN M. DOE, JOHN DOE, J.M.DOE, and all other variations however styled, punctuated, spelled, ordered, or otherwise represented as pertaining to me and my estate, and hereby declare their permanent domicile on the land and soil of Wisconsin.  
All prior Powers of Attorney, all other prior presumed or granted Executorships, Guardianships, and Agency relationships are terminated and revoked effective with my natural birthday July 7, 1900, as I elect to be recognized as the sole living owner, executor, beneficiary, and agent of my name and estate since my 21st birthday on July 7, 1921. 
So said, so signed, and so sealed by my living hand this 2nd day of October in the year 2021 by: 

                       By:  _____________________________________   seal    LS  

Witness Jurat
Wisconsin	}
Dane County 	}

I, a Wisconsin Assembly Recording Secretary, was visited today by the living man known and identified as John Mark Doe and he did sign and seal this Acknowledgement, Acceptance and Deed of Re-Conveyance in my presence and did affirm the same in my sight, whereupon I affix my signature and seal as testimony to these facts: 

Wisconsin Assembly Recording Secretary _____________________________________
Revision 06202021							        Seal

Instructions
After you have added in your own names and information replacing or erasing the items highlighted in red, simply change the text color back to black.  Please note that the first name appearing needs to be the name your parents gave you at birth as it appears on your birth certificate, written in Upper and Lower Case, for example: Marjorie Anne Brown —not any variation. 
If your birth name was John Mark Doe that is what needs to come after “I, the living man….” and it also needs to appear as “given lawful trade name” and that name also needs to be included in the list of variations.  You can also claim any other names you may have used over the years and their variations—pen names, married names, adopted names, nicknames you are known by, abbreviations of your name, etc.  Just make sure you list as many variations both in Upper and Lower Case and in all capitals as you know you have used or someone else might use in reference to you.  At a very minimum, list the all capital variations that are known to be active--- JOHN DOE (Ward of the State), JOHN MARK DOE (Cestui Que Vie Trust) and JOHN M. DOE (Public Transmitting Utility). 
Notice the difference in the notary block.  It’s “Wisconsin State” not “State of Wisconsin”.    It’s “Dane County” not “County of Dane”.     
When you sign it, you will want to sign it in front of the notary in red ink for the Deed of Reconveyance and blue ink for all other documents and you will want to seal the signature with your right thumbprint in red ink. Your thumbprint should touch but not obscure your signature.  The “LS” behind your signature stands for “Living Soul”.  This should  be used on the Deed of Reconveyance, but not the other documents.  The use of a “by-line” establishes your authorship of the text and ownership of the signature.  Add a copyright symbol after your signature to further nail it down:  
	                                       by:  John Mark Doe©