Date of Birth
- Hunter Blain
- Jun 26
- 4 min read
"I'd still rather not." Paul explained. "I don't really want to get into my reasoning, but I'm still allowed to say no, right?"
"Absolutely. I just need you to fill out these then."
As he sat down in the drab waiting room, Paul looked around at the handful of patrons consumed by their forms or waiting to be served. Paul turned his attention to his own paperwork.
"Okay. Just a form. Shouldn't be too much trouble."
Department of Health, Passing, and Human Services
Form 1999: Miscellaneous Request
Part A
1. Name: Paul Waterman
2. Date of Birth: February 11, 1984
3(a). Sex Assigned at Birth: F
3(b). Current Sex (if different): M
4. Marital Status: Single
5. Religion: Prefer not to say
6. Function: Undefined
7. Unique Identifier: 766-64-1122
8. Physical Address
[X] Check Box if Officially Linked to Unique Identifier and Leave Remainder Blank
Street Number and Name:
Address Line 2 (if any):
City or Town:
State:
9. Citizenship Status: Natural Born Citizen
10. Preferred Interface Type (check box):
[_] Direct
[_] Wearable
[_] Handheld
[X] Standalone (Portable)
[_] Standalone (Home)
[_] Other (Please specify) __________________
11. Please Check Any That Apply
(for purposes of this section, the term "Misdemeanor" does not include minor traffic violations)
(a) [_] Convicted of Misdemeanor
(b) [_] Convicted of Felony
(c) [X] Arrested for Misdemeanor
(d) [_] Arrested for Felony
(e) [_] Severe Disability
(f) [X] Adverse Mental Health Diagnosis Requiring Hospitalization
(g) [_] Direct Relation to an Individual Convicted of a Misdemeanor
(h) [X] Direct Relation to an Individual Convicted of a Felony
(i) [X] Chemical Dependency (current)
(j) [X] Chemical Dependency (past)
(k) [_] Served in Armed Forces (any)
(l) [X] Direct Relation to Individual who Served in Armed Forces (any)
(m) [X] Weapons Training of Any Kind
Part B
Please provide explanations for any checked boxes in question 11.
Related Question(s): 11(c)
Explanation: Wrongful arrest.
Related Question(s): 11(f)
Explanation: Severe mood disorder, which has resulted in five hospitalizations.
Related Question(s): 11(h)
Explanation: Identical sibling involved in organized resistance. Have cut ties as per government direction.
Related Question(s): 11(i) and 11(j)
Explanation: Reliant on quetiapine (daily use).
Related Question(s): 11(l)
Explanation: See explanation for question 11(h).
Related Question(s): 11(m)
Explanation: Received weapons training at young age out of country.
The undersigned certifies that this form is true, accurate and complete. The undersigned further agrees to supplement this form with any other information that arises.
Signed: Paul Waterman
Date: February 11, 2054
Paul flipped the page. Another form to fill out.
Department of Health, Passing, and Human Services
Form 1289A: Declining Government Benefit
1. Name: Paul Waterman
2. Date of Birth: February 11, 1984
3(a). Sex Assigned at Birth: F
3(b). Current Sex (if different): M
4. Function: Undefined
Please check the government benefit you wish to decline.
[ ] Retirement Pension
[ ] Housing Assistance
[ ] Dietitian Services
[ ] Implantable Technology Subsidies
[ ] Implant Maintenance Services
[X] Mortality Preservation
[ ] Other (please specify): _________________________
If declining Mortality Preservation, please fill out Form 1289B.
The undersigned certifies that this form is true, accurate and complete.
Signed: Paul Waterman
Date: February 11, 2054
Paul turned the page, where he found one final form.
Department of Health, Passing, and Human Services
Form 1289B: Declining Mortality Preservation
1. Name: Paul Waterman
2. Date of Birth: February 11, 1984
3(a). Sex Assigned at Birth: F
3(b). Current Sex (if different): M
4. Function: Undefined
By filling out this form, you are declining Mortality Preservation, an essential right to all. Please check all the below to acknowledge your understanding of waiving this important right. If you no longer wish to waive Mortality Preservation, please check this box: [ ].
Failing to undergo Mortality Preservation means that you will not pass. Please check this box to confirm: [X].
Failing to undergo Mortality Preservation means that any loved ones who pass will not be able to interact with you. An artificial model based on your writings or other scannable data may be created for this or other purposes. Please check this box to confirm: [X].
In the case of an accidental preservation, you will have to go through the same termination procedures as if you had not declined Mortality Preservation. Please check the box to confirm: [X].
Signed: Paul Waterman
Date: February 11, 2054
Paul returned to the line and passed the paperwork back to the clerk.
"Thanks! We should get back to you within a few months with your approval." The clerk spouted off the line robotically. Paul could tell the clerk said that exact sentence countless times over the course of their career.
"I don't know that I have a few months." Paul replied.
"Well, you should have done this earlier." The clerk snapped.
"What happens if it isn't approved before it's time?"
"We have to proceed with the preservation."
"I don't want that. Don't I get a choice here? It's my life!"
"And you'll get to keep on living. I really don't understand what your problem is."
"I don't have to explain myself. I'm not explaining myself. But I don't want it."
Something in Paul's eyes got to the clerk in a way his words had not.
"Well, I'll see if I can put a rush on this. I think I can print out a temporary approval. Just make sure you have it on you because it won't be in any system. Even then, no guarantees. I'd make sure it's displayed as prominently as possible because you aren't exactly going to be in a position to hand it over."
"Thank you. That's a relief."
The clerk's printer spat out a small rectangle. Paul took the small piece of paper that separated him from eternity. He had enough.
"One more thing!"
Paul turned back around. "Yes?"
"Happy birthday, Paul."
***
Instead of a separate proof of concept piece, I'll just redirect you to form I-821 (and just all the forms that they have).
