Habbitual Sin Issues  A)_________________B)__________________C)___________________________

 EMOTIONAL PROBLEMS,
Depression_____  Suicidal_______ Anger_____ Hate____ Rage_____ Unforgiveness_____________
Toward Who?_________________  ________________   _______________  ________________

CONFLICTS AND CONDITIONS

In family relationships _____ Relationship to other person or people _____ WHO?_________________________________
Extreme or abnormal habit/condition _______ Fear _____ Self pity _____ Envy ____ Pride ____ Jealousy ____  Resentment ____ Bitterness _____ Racism _____ Anti Semitism _____ Or any other _____ Discontentment with self _____ Spouse _____ 
Family _____ Circumstances _____  other. ______.  Unpredictability _____ Doubt _____ Unbelief _____ Self punishment _____ (Mental ______ Physical ________ )    If so describe here _________________________________________________________ ________________________________________________________________________________________________________.

TRAUMATIC EXPERIENCES

In Uterus? ____ Childhood ? _____ Teenage ? ____ Adulthood? ____ Of what sort? _______________________________
Abortion______ Murder_______ Rape_______ Incest______Molestation_____  Sexual Abuse________ Emotional Abuse_______ Controlled by Other_______Who_______________________________
Sudden death of loved one. ______.  Physical attack ______ or any other _____ 
If so describe.________________________________________________________________________________________._ 
Divorce________ ( Does it run in generation ( Family ), check below also )

 DESTRUCTIVE HABITS

Lying ____ Blasphemy ____ Smoking _____ Drinking ______ Drugs____Temper _____ Lust ____ Anorexia/Bulimia _____ 
Stealing _____ Constant criticism _____ Gossip ____ Gluttony ____ Cutting_____
Others (List) _______________________________________________________________________

IMMORAL CONDITIONS 

Homosexuality _____ Lesbianism _____ Bi-sexuality _____ Sodomy _____ Indecent exposure ____ Masturbation _____
Adultery _____ Fornication _____ Incest ______ Rape ______ Bestiality _____ Porno____others ______ 
if so describe here. ____________________________________________________________________________________
Have desires of above nature. _____ Have pictures/videos/books of above nature _______

SOUL TIES  ( Un-Godly Relationships ) ( Certain Friends, Family, Witches, etc.)
Emotional______ who?_____________________________________________________________
Sexual_______Who?_______________________________________________________________
Other Ungodly Relationships______Who?_____________________________________________

 OCCULT ACTIVITY  ( Past or present)

Have you ever sought or been subjected to as a child, HEALING, through magic conjuration and charming, such as:
Removal of warts and burns, or disease etc ____ treated by or through a spiritualist ____ Christian scientist ___  spirit healer ____ 
Psychic healing _____ Hypnosis _____ Metaphysical healing _____ Any evil doctrine ______________________________ 
Use of the pendulum ______Divining ______ ( all forms e.g. Water Witching Rods, wedding ring, needle and thread, etc). 
Have you ever practiced : levitation? _____ or automatic (spirit ) writing? ______ 
Have you used or worn an amulet, talisman or Rabbits foot (any good Luck Charms) _______ Magic Charms_____ 
Have you ever had acupuncture ( based on 'lines' similar to the zodiac) ___ or of any sort ____________________.
Have you ever been involved in Halloween or trick or treating ______. 
Have you ever been involved in martial art in any form? ____ If so what form _______________________________________
Have you ever practiced meditation ______ Do you have now or have you ever had a spirit guide ____
Practiced mental suggestion _____ or cast a magic spell (even in fun)? _____ Telepathy____ E.S.P._______
Have you ever participated  in: Satan Worship _____ Witchcraft____ Wiccan____ Black Magic_____White Magic___
Angel Worship______ A Practicing Medium_____Chain Letters___
Have you visited or used a : Psychic____  Palm reader, ____  Crystal ball gazer _____ Tea Leaves____ Tarrot Cards____ 
Horoscopes_____  Hypnotized_____  Yoga____  Séance___ Spiritist Meeting____ Life/Reincarnation reading____ 
A Ouija Board_____  Psychic Annalist___  Other_____________________________________________________________
Have you had an: Imaginary Playmate _____ or any Spirit visitors _____ or Ancestors visiting____ 

 ARTICLES OR ARTIFACTS WHICH MAY BE PRESENT IN YOUR HOME.

Tarot cards ____ Crystals ____ Energy balls _____Games of occult nature _____ Good luck charms ____   Amulets ____ 
Occult Carvings  ______  Occult Jewelry _____ Heavy Metal Rock Or Rap music _____ Occult or pagan religious objects ______ Any Pagan God images( Budda, Sun God, Egyptian, etc) _____ Relics or artifacts ______ which may have been used in pagan temples and religious rites  or in the practice of sorcery, magic divination, or spiritualism.
Any and "all Indian" items______(dream catchers indian pictures or jewelry etc).
Graven Images of God______( pictures of jesus, jesus on a cross etc.)
Masonic Lodge items_____ Mormon Items____
Do you have books, comics, or videos on occult _____ Vampires ____ The weird _____ horror___ 

Do you read or have in your home any occult, spiritualist or new age books such as: Books on astrology ______
interpretation of dreams _____ Metaphysics _____ Religious cults _____ Self realization _____ Fortune telling ____ 
Black Magic ____ E.S.P. ____ clairvoyance _____ physic phenomena _____ Mind control _____ Meditation _____
Altered states of consciousness ______ New age healing___ U.F.O's____. Other_______________________________

Any and "all Catholic" items(rosery,crucifix,statues etc.)_____________________________________
Halloween Items and Decorations_____

CULTS and RELIGIONS  WITH WHICH YOU HAVE BEEN CONNECTED. (Directly or indirectly)

Herbert W Armstrong. ___ Hare Krishna ____ Scientology ____ Buddhism ____ Zen Buddhism ____  Mormons ____ 
Christian scientists ____ Unity ____ Catholosism____ Orthodox____Unitarian ______ Jehovah's Witnesses _____ 
Transcendental Meditation _____ Unification Church ( Moon) _____ Children of God ____  Spiritual Frontiers Fellowship ____ Religious research of America ____ The Way _____ The Forum ____Satanism_____ Witchcraft____ 
Metropolitan Community Church ( MCC homosexual church organization ) _____Mother Earth__________
Other___________________________________________________________________________________
Have you or family now or in the past been involved in the Masonic lodge _____ Illuminati_____
or any other secret society___________________________________________________

 DRUGS AND ALCOHOL ABUSE
Are you or have been a drug user or pusher ____

LSD ___ STP ____ Heroin ___ Crack ___ Speed ____ Methedrine. ____ Amphetamines ( uppers ) ____ Nembutal ____ 
Marijuana _____ Hashish _____ THC _____ Cocaine _____ Peyote ____ Pain killers ( addiction ) _____Sleeping Pills_____
or any other ______ if so show here. _______________________________________________________________________
Drinking and Drunkardness___ Alcoholic____

 CONDEMNATION ---- GUILT.

In regard to Past sins _____ Fear of committing sins ____ Unpardonable sin _____ Abortion___ Divorce / remarriage ____ 
Fear of being unforgiven ____ Unforgiven: e.g. expressed in anger etc _____ any other ______ 
if so show here _____________________________________________________________________________________

UNGODLY TATTOOS (SKULLS, DEMONS,EVIL ETC) Describe here_________________________________________________

Many Demons work legaly through the generational curses. List all sins of the forefathers and compare with sins and strongholds above.
What same sin(s) do you have that either of your parents have? list below:
Generational Sins and Curses (Forefathers)
MOM'S SIN ISSUES______________________________________________________________
DAD'S SIN ISSUES_______________________________________________________________
GRANDPA (MOM'S SIDE)___________________________________________________________
GRANDMA (MOM'S SIDE)___________________________________________________________
GRANDPA (DAD'S SIDE)_____________________________________________________________
GRANDMA (DAD'S SIDE)____________________________________________________________
GREAT GRANDPARENTS (IF KNOWN)_______________________________________________
SISBLINGS______________________________________________________________________
UNCLES, AUNTS, RELATIVES________________________________________________________

OTHER NOTES AND COMMENTS   ________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Copyright 2001:
Bill Niland, kickdemonbutt ministry     E-Mail:  kickdemonbutt@yahoo.com

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