State of Georgia Liability Incident Report Form: Accident Information - General Liability

STATE OF GEORGIA
Liability Incident Report Form
If property of others is damaged (or alleged) or there is an injury as a result of the State’s
operations, whether negligent or not, report the claim directly to DOAS / Risk Management
Services by faxing this completed form to: Department of Administrative Services and
email to: mark.mckinney@doas.ga.gov or fax to 404-657-1188.
Time is of the essence. Do not delay reporting the claim because you do not have all the
information regarding the accident. Any additional information can be provided at a later
date. Use multiple sheets for more than one Claimant.
Accident Information - General Liability
State Agency involved:
PRINCIPALS - THE STATE COURT OF GWINNETT COUNTY STATE OF GEORGIA , THE

STATE OF GEORGIA, THE COUNTY OF GWINNETT, THE GWINNETT COUNTY
SHERIFFS DEPARTMENT, THE GWINNETT COUNTY DETENTION CENTER,
AGENTS – ALL CONSPIRATORS IN CASE 2016D-00833-1 Emily J. Brantley, Rosanna
Szabbo, Lewis Lawrence, Shawn McKean, Ryan Fisher, Butch Conway, The clerks of court,
unidentified arresting bailiff, male judge, other agents as apply, The GWINNETT COUNTY
BOARD OF COMMISSIONERS, et al etc.
Date of the incident:
Through 3/21/2016 – 10/03/2016
Incident time:
Various times included within the dates
Incident location:
AT THE STATE COURT OF GWINNETT COUNTY STATE OF GEORGIA AT THE

GWINNETT JUSTICE AND ADMINISTRATION CENTER, 75 LANGLEY DRIVE
LAWRENCEVILLE. GEORGIA. [30246]
City and County:
LAWRENCEVILLE, GEORGIA
Description of the incident:

Trespass upon Estate, Treason, Violation of Oaths, False Claims, Trespass on case, Violation of
rights. Conspiracy to violate rights, Fraud upon the court by the court, Artifice to defraud,
Racketeering, Violation of Foreign Sovereign Immunities Act, false imprisonment, Identity theft,
Violation of due process of law, sham legal process, R.I.C.O., Denial of honest services, mail
fraud, personage, barratry, color of state law violations, color of authority violations, excess of
delegated authority, acts ultra vires of franchisee, excess of jurisdiction, and numerous other
UNCONSTITUTIONAL, ULTRA VIRES criminal actions by all agents and corporations in
violation of Franchises Claimed
Police authorities contacted:
HAVE NOT SOUGHT CRIMINAL CHARGES AT THIS POINT
If yes, Accident Report Number:
Claimant Information
Name & address of the Claimant:
Tort Claimant – Injured Party – Trustee/Secured Party/Bailor/Executor of Estate

Thomas-William: Healan Jr. Executive Trustee of the THOMAS WILLIAM HEALAN JR. ©
TRUST A Common-Law Pure Trust created in the De-Jure united States of America Republic
194 Etheridge Road, on Auburn, on Georgia Republic, Near. [30011-9998] non-domestic
Home Telephone No. 762-436-1168 or 770-963-5791 or 404-913-6181
Work Telephone No. 762-436-1168
Injured party date of birth:
THOMAS WILLIAM HEALAN JR. Trust/Estate 09/21/1963
Social Security No. 257-21-6439
Injured Party date of Nativity:
A Living, Flesh, and Blood, Soul, Sentient Man- Thomas-William: Healan Jr. Executive
Trustee/Executor of the above Trust Date of Nativity was on the twenty first day of September
in the year nineteen hundred sixty three at approximately six minutes after midnight on the
republic of the De-Jure united States of America.
The Living Man has no Socialist Security Number

Injury Information
Brief description of the claimant’s injury:
falsely imprisoned for 181 days denied rights, numerous violations and injuries per case 2016D-
00833-1
ESTATE WAS ARROGATED/ADMINISTERED BY EXECTOR DE SON TORT
BID BONDS ETC. FALSE SECURITIES/BONDS/DEBTS CREATED
Fatality: No
What initial treatment was given?
Refuse to dismiss fraudulent charges, case , when living man presented evidence of fraud was
arrested while accepting oaths of all agents involved in case 2016D-00833-1 on 05/02/2016
By whom?
UNIDENTIFIED BAILIFF/DEPUTY
Was hospital treatment needed?
Was needed twices during incarceration, was denied medical/dental treatment in violaton of 8 te
amendment
Which hospital?
Not applicable
Witness Information 
Available when needed. Recording of arraignment on telephone, certified documents, affidavits

filed in clerks office,
Were there any witnesses?
Yes, Available
If so, their name, address & phone no:
ASK SECRETARY OF STATE OR GOVERNOR OR ATTORNEY GENERAL
Property Damage to Others Information
Claimant’s property involved:

BURGLARY OF CABINET SHOP AND HOME DUE TO INCARCERATION WAS UNABLE
TO SECURE OR KEEP WATCH OVER MY PROPERTY DUE TO A BURGLARY LOST A
VEHICLE, ALL TRADE TOOLS USED TO EARN LIVING, ALL HOUSEHOLD ITEMS
WASHERS, DRYERS, COMPUTERS , TV’S, ETC. TOTAL LOSS OF OVER $200,000.00
181 DAYS IN JAIL LOSS OF FREEDOM. AT AGREED UPON CONTRACT RATE OF

$20,000.00 PER HOUR PER UNREBUTTED AFFIDAVIT FILED INTO CLERKS OFFICE
OF COURT BEFORE ARREST. TOTAL CLAIM DUE PER MUTUAL AGREEMENT AND
CONTRACTED RATE OF AGENTS AND CORPORATIONS $86,800,000.00 (eighty six
million, eight hundred thousand dollars)
Where is the property located now?

 
Damage to Claimant’s property:
TOTAL LOSS OF ALL PROPERTY

  
Repair estimate:
$250,00.00 (two hundred fifty thousand dollars)
Comments:
This is an agreed on contracted fee for color of law, violations of rights, malicious prosecution
agreed upon by principal and agent and the total due is $86,800,000.00 (eighty six million, eight
hundred thousand dollars)
Your Name: I AM Thomas-William: Healan Jr. a child of Yahweh
Your Phone Number: 762-436-1168 or 770-963-5791 or 404-913-6181
Affidavit Affirming Claim Submitted To Clerk of Court, Insurance Commissioner as they

refused to reveal jurisdiction, oaths, bonds, (insurance fraud), State Attorney General, For
noticing, claim lawful/legal purposes
This Claim is on all Principals, and, Agents, to include Bonding, Surety, CAFR, Insurances,
Franchises, Properties, etc,

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STATE OF GEORGIA

Liability Incident Report Form

Accident Information - General Liability

State Agency involved:

PRINCIPALS - THE STATE COURT OF GWINNETT COUNTY STATE OF GEORGIA , THE

Date of the incident:

Through 3/21/2016 – 10/03/2016

Various times included within the dates

AT THE STATE COURT OF GWINNETT COUNTY STATE OF GEORGIA AT THE

City and County:

Description of the incident:

Police authorities contacted:

HAVE NOT SOUGHT CRIMINAL CHARGES AT THIS POINT

If yes, Accident Report Number:

Name & address of the Claimant:

Tort Claimant – Injured Party – Trustee/Secured Party/Bailor/Executor of Estate

Home Telephone No. 762-436-1168 or 770-963-5791 or 404-913-6181

Work Telephone No. 762-436-1168

Injured party date of birth:

THOMAS WILLIAM HEALAN JR. Trust/Estate 09/21/1963

Social Security No. 257-21-6439

Injured Party date of Nativity:

The Living Man has no Socialist Security Number

What initial treatment was given?

Was hospital treatment needed?

Available when needed. Recording of arraignment on telephone, certified documents, affidavits

Were there any witnesses?

If so, their name, address & phone no:

ASK SECRETARY OF STATE OR GOVERNOR OR ATTORNEY GENERAL

Property Damage to Others Information

Claimant’s property involved:

181 DAYS IN JAIL LOSS OF FREEDOM. AT AGREED UPON CONTRACT RATE OF

Where is the property located now?

TOTAL LOSS OF ALL PROPERTY

$250,00.00 (two hundred fifty thousand dollars)

Your Name: I AM Thomas-William: Healan Jr. a child of Yahweh

Your Phone Number: 762-436-1168 or 770-963-5791 or 404-913-6181

Affidavit Affirming Claim Submitted To Clerk of Court, Insurance Commissioner as they

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