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UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA ORLANDO DIVISION [NAME] Plaintiff. Case No.

XXXXXX -vCAPITAL ONE BANK, CAPITAL ONE SER ICES, INC. !efen"ants. SECOND AMENDED COMPLAINT Plaintiff, [Na#e], $e%e&' s(es !efen"ants, Ca)ital One Ban*, an (n*no+n entit', an" Ca)ital One Se%vi-es, In-., a !ela+a%e Co%)o%ation, an" alle.es/ PRELIMINARY STATEMENT 0. T$is is an a-tion fo% "a#a.es &%o(.$t fo% "a#a.es fo% violations of t$e 1ai% !e&t Colle-tion P%a-ti-es A-t 21!CPA3 04 5.S.C. 60789 et seq., fo% "a#a.es fo% violations of t$e Florida Consumer Collection Practices Act (FCCPA), Fla. Stat. 6559(Part VI), an" fo% "a#a.es fo% violations of t$e 1ai% C%e"it Re)o%tin. A-t 21CRA3 04 5.S.C. 607:0 et seq. JURISDICTION AND VENUE 9. T$e ;(%is"i-tion of t$is Co(%t is -onfe%%e" &' 04 5.S.C. 607:0) an" 15 U.S.C. 61692 . !"e court "as su##lemental $urisdiction o%er state la& claims. <. en(e is )%o)e% in t$is !ist%i-t )(%s(ant to 9: 5.S.C. 60<80&.

=. T$is is an a-tion fo% "a#a.es +$i-$ e>-ee" ?@4,AAA.AA. 4. Plaintiff, [Na#e], is a nat(%al )e%son an" is a %esi"ent of t$e State of 1lo%i"a. 7. !efen"ant, CAPITAL ONE BANK 2BCa)ital One Ban*C3, is an (n*no+n entit', not a(t$o%iDe" to "o &(siness in 1lo%i"a. @. !efen"ant, CAPITAL ONE SER ICES, INC. 2BCa)ital One Se%vi-esC3, is a !ela+a%e Co%)o%ation, a(t$o%iDe" to "o &(siness in 1lo%i"a. :. All -on"itions )%e-e"ent to t$e &%in.in. of t$is a-tion $ave &een )e%fo%#e", +aive" o% e>-(se".

FACTUAL ALLEGATIONS 8. In 9AA0, Plaintiff o&taine" a -%e"it -a%" f%o# !efen"ant Ca)ital One Ban*. T$e -a%" 2a--o(nt en"in. in =@093 +as t$e onl' Ca)ital One a--o(nt t$at Plaintiff $as eve% $a". T$e a--o(nt +as -lose" +it$in a fe+ #ont$s +$en !efen"ant Ca)ital One Ban* %ef(se" to a&i"e &' t$e 1ai% C%e"it Billin. A-t in %eve%sin. ille.iti#ate -$a%.es. 0A. A&o(t t$e sa#e ti#e t$at t$e a--o(nt +as -lose", !efen"ants Ca)ital One Ban* an" Ca)ital One Se%vi-es &e.an %e)o%tin. false info%#ation a&o(t t$e a--o(nt to t$e -%e"it %e)o%tin. a.en-ies, EE(ifa>, E>)e%ian, an" T%ans 5nion, an" -ontin(e" to "o so "es)ite PlaintiffFs n(#e%o(s "is)(tes a&o(t t$e a--o(nt t$at +e%e t%ans#itte" t$%o(.$ t$e -%e"it %e)o%tin. a.en-ies. !efen"ants Ca)ital One Ban* an" Ca)ital One Se%vi-es $ave %e)eate"l' faile" to -on"(-t a )%o)e% investi.ation of PlaintiffFs "is)(tes an" %e)eate"l' faile" to info%# t$e -%e"it %e)o%tin. a.en-ies t$at t$e a--o(nt is in "is)(te. 00. At t$e ti#e t$e a--o(nt +as -lose", t$e%e +as a "is)(te" &alan-e of less t$an ?<AA. Sin-e t$en !efen"ants Ca)ital One Ban* an" Ca)ital One Se%vi-es, "i%e-tl' an" t$%o(.$ ot$e% entities, $ave &een atte#)tin. to -olle-t on +$at t$e' no+ -lai# to &e a &alan-e of a))%o>i#atel' ?9,<AA. Neit$e% !efen"ant $as eve% )%ovi"e" to Plaintiff an a--o(ntin. of t$e alle.e" "e&t no% an' -ont%a-t o% ot$e% le.al ;(stifi-ation fo% atte#)tin. to -olle-t it. In fa-t, !efen"ant Ca)ital One Se%vi-es $as %e)eate"l' info%#e" Plaintiff t$at it -an fin" no %e-o%" of PlaintiffFs a--o(nt, onl' t$%ee ot$e% a--o(nts +$i-$ it falsel' -lai#s &elon.e" to Plaintiff. 09. On Se)te#&e% 0, 9AA7, !efen"ant Ca)ital One Se%vi-es sent Plaintiff a lette% in"i-atin. t$at t$e alle.e" "e&t $a" &een -$a%.e" off 'et still -ontin(e" to a--%(e inte%est of 94.8G )e% 'ea%. T$e lette% state" t$at BT$is is an atte#)t to -olle-t a 2-ons(#e%3 "e&t 2-lai#3. An' info%#ation o&taine" +ill &e (se" fo% t$at )(%)ose.C an" BT$is -o##(ni-ation is f%o# a "e&t -olle-to%.C Ho+eve% t$e lette% -lea%l' in"i-ate" t$at t$ese state#ents "i" not a))l' to Plaintiff, &(t onl' to %esi"ents of -e%tain states ot$e% t$an 1lo%i"a, +$e%e Plaintiff %esi"es. 0<. On O-to&e% 9=, 9AA7 TSIS Total !e&t Mana.e#ent 2TSIS3 file" a P%oof of Clai# in PlaintiffFs &an*%()t-' see*in. ?9,<9<.89 on &e$alf of !efen"ant Ca)ital One Ban*. A -o)' of t$e P%oof of Clai# +as not sent to Plaintiff. 0=. On Ma%-$ 9@, 9AA@ Plaintiff sent a lette% to TSIS "e#an"in. vali"ation of t$e alle.e" "e&t. T$e lette% +as sent &' -e%tifie" #ail an" %e-eive" &' !efen"ant TSIS on Ma%-$ <A, 9AA@. TSIS "i" not %es)on" to t$e lette%. 04. On A)%il 0=, 9AA@ Re.ional A";(st#ent B(%ea(, In-. 2RAB3 -alle" Plaintiff atte#)tin. to -olle-t on t$e alle.e" "e&t. 07. On A)%il 07, 9AA@ RAB sent a lette% to Plaintiff atte#)tin. to -olle-t on t$e alle.e" "e&t. 0@. On A)%il 0:, 9AA@ RAB -alle" Plaintiff atte#)tin. to -olle-t on t$e alle.e" "e&t.

0:. On A)%il 94, 9AA@ Plaintiff sent a lette% to RAB "e#an"in. vali"ation of t$e alle.e" "e&t. T$e lette% +as sent &' -e%tifie" #ail an" %e-eive" &' RAB on Ma' 0, 9AA@. 08. On Ma' 0, 9AA@ RAB -alle" Plaintiff atte#)tin. to -olle-t on t$e alle.e" "e&t. 9A. On Ma' 9, 9AA@ RAB sent a lette% to Plaintiff atte#)tin. to -olle-t on t$e alle.e" "e&t. T$e lette% "i" not vali"ate t$e alle.e" "e&t. 90. On Ma' 9, 9AA@ !efen"ant Ca)ital One Se%vi-es sent Plaintiff a lette% in"i-atin. t$at it -o(l" not fin" an' %e-o%" of PlaintiffFs a--o(nt. T$e lette% faile" to "is-lose t$at t$e -o##(ni-ation is f%o# a "e&t -olle-to%. 99. On J(ne @, 9AA@ Plaintiff sent a lette% entitle" BNOTICE O1 PEN!INK LALS5ITC to !efen"ant Ca)ital One Ban* "e#an"in. t$at it an" TSIS an" RAB -ease violatin. fe"e%al an" state la+s at PlaintiffFs e>)ense. T$e lette% +as sent &' -e%tifie" #ail an" %e-eive" &' !efen"ant Ca)ital One Ban* on J(ne 04, 9AA@. Co)ies of t$e lette% +e%e also sent to TSIS an" RAB. 9<. On J(ne <A, 9AA@ !efen"ant Ca)ital One Se%vi-es sent Plaintiff a lette% %es)on"in. to t$e BNOTICE O1 PEN!INK LALS5ITC in"i-atin. t$at it -o(l" not fin" an' %e-o%" of PlaintiffFs a--o(nt. Also en-lose" +it$ t$e #ailin. +as a -o)' of PlaintiffFs BNOTICE O1 PEN!INK LALS5IT.C T$e lette% faile" to "is-lose t$at t$e -o##(ni-ation is f%o# a "e&t -olle-to%. 9=. On J(l' 0@, 9AA@ !efen"ant Ca)ital One Se%vi-es sent Plaintiff a lette% %eE(estin. -onsent to sen" info%#ation a&o(t t$e alle.e" a--o(nt to a t$i%" )a%t'. T$e lette% faile" to "is-lose t$at t$e -o##(ni-ation is f%o# a "e&t -olle-to%. 94. On Se)te#&e% @, 9AA@ !efen"ant Ca)ital One Se%vi-es a.ain sent Plaintiff a lette% %eE(estin. -onsent to sen" info%#ation a&o(t t$e alle.e" a--o(nt to a t$i%" )a%t'. T$e lette% faile" to "is-lose t$at t$e -o##(ni-ation is f%o# a "e&t -olle-to%. 97. On Se)te#&e% 0@, 9AA@ Plaintiff file" a Co#)laint in t$is a-tion a.ainst !efen"ant Ca)ital One Se%vi-es, TSIS, an" RAB. 9@. On Nove#&e% 0, 9AA@ Plaintiff vol(nta%il' "is#isse" +it$ )%e;("i-e t$e a-tion a.ainst TSIS afte% TSIS )ai" Plaintiff an (n"is-lose" a#o(nt of #one'. 9:. On !e-e#&e% 9A, 9AA@ Plaintiff vol(nta%il' "is#isse" +it$ )%e;("i-e t$e a-tion a.ainst RAB afte% RAB )ai" Plaintiff ?=,AAA.AA. 98. Plaintiff -onten"s t$at t$e ille.al a-tions of !efen"ants Ca)ital One Ban* an" Ca)ital One Se%vi-es $ave $a%#e" t$e Plaintiff, %es(ltin. in -%e"it "enials, -%e"it "ela's, ina&ilit' to a))l' fo% -%e"it, finan-ial loss, loss of (se of f(n"s, #ental an.(is$, $(#iliation, a loss of %e)(tation, an" e>)en"it(%es fo% atto%ne'Ms fees an" -osts.

COUNT I VIOLATION OF FAIR DEBT COLLECTION PRACTICES ACT (FDCPA), 15 U.S.C. 1692 BY DEFENDANT CAPITAL ONE SERVICES <A. Pa%a.%a)$s 0 t$%o(.$ 98 a%e %ealle.e" as t$o(.$ f(ll' set fo%t$ $e%ein. '1. Plainti(( is a consumer &it"in t"e meanin) o( t"e F*CPA, 15 U.S.C. 61692a('). '2. *e(endant Ca#ital +ne Ser%ices is a de,t collector &it"in t"e meanin) o( t"e F*CPA, 15 U.S.C. 61692a(6). ''. !efen"ant Ca)ital One Se%vi-es violate" t$e 1!CPA. !efen"antFs violations in-l("e, &(t a%e not li#ite" to, t$e follo+in./ (a) *e(endant Ca#ital +ne Ser%ices %iolated 15 U.S.C. 61692e(2) ,(alsel- re#resentin) t"e c"aracter, amount, or le)al status o( ande,t. (,)*e(endant Ca#ital +ne Ser%ices %iolated 15 U.S.C. 61692e(.) ,communicatin) or t"reatenin) to communicate to an- #erson credit in(ormation &"ic" is no&n or &"ic" s"ould ,e no&n to ,e (alse, includin) t"e (ailure to communicate t"at a dis#uted de,t is dis#uted. (c) *e(endant Ca#ital +ne Ser%ices %iolated 15 U.S.C. 61692e(1/) ,t"e use o( an- (alse re#resentation or dece#ti%e means to collect or attem#t to collect an- de,t or to o,tain in(ormation concernin) a consumer. (d)*e(endant Ca#ital +ne Ser%ices %iolated 15 U.S.C. 61692e(11) ,t"e (ailure to disclose in t"e initial &ritten communication &it" t"e consumer t"at t"e de,t collector is attem#tin) to collect a de,t and t"at an- in(ormation o,tained &ill ,e used (or t"at #ur#ose, and t"e (ailure to disclose in su,se0uent communications t"at t"e communication is (rom a de,t collector. (e) *e(endant Ca#ital +ne Ser%ices %iolated 15 U.S.C. 61692((1) ,- t"e collection o( an- amount (includin) an- interest, (ee, c"ar)e, or e1#ense incidental to t"e #rinci#al o,li)ation) unless suc" amount is e1#ressl- aut"ori2ed ,- t"e a)reement creatin) t"e de,t or #ermitted ,- la&. (() *e(endant Ca#ital +ne Ser%ices %iolated 15 U.S.C. 61692) ,-, +it$in five "a's afte% t$e initial -o##(ni-ation +it$ Plaintiff in -onne-tion +it$ t$e -olle-tion of an' "e&t, failin. to sen" Plaintiff a +%itten noti-e -ontainin. a state#ent t$at (nless t$e -ons(#e%, +it$in t$i%t' "a's afte% %e-ei)t of t$e noti-e, "is)(tes t$e vali"it' of t$e "e&t, o% an' )o%tion t$e%eof, t$e "e&t +ill &e ass(#e" to &e vali" &' t$e "e&t -olle-to%, a state#ent t$at if t$e -ons(#e% notifies t$e "e&t -olle-to% in +%itin. +it$in t$e t$i%t'-"a' )e%io" t$at t$e "e&t, o% an' )o%tion t$e%eof, is "is)(te", t$e "e&t

-olle-to% +ill o&tain ve%ifi-ation of t$e "e&t o% a -o)' of a ;(".#ent a.ainst t$e -ons(#e% an" a -o)' of s(-$ ve%ifi-ation o% ;(".#ent +ill &e #aile" to t$e -ons(#e% &' t$e "e&t -olle-to%, an" a state#ent t$at, ()on t$e -ons(#e%Ms +%itten %eE(est +it$in t$e t$i%t'-"a' )e%io", t$e "e&t -olle-to% +ill )%ovi"e t$e -ons(#e% +it$ t$e na#e an" a""%ess of t$e o%i.inal -%e"ito%, if "iffe%ent f%o# t$e -(%%ent -%e"ito%. LHERE1ORE, Plaintiff "e#an"s ;(".#ent fo% "a#a.es a.ainst !efen"ant Ca)ital One Se%vi-es fo% a-t(al o% stat(to%' "a#a.es, an" )(nitive "a#a.es, atto%ne'Ms fees an" -osts, )(%s(ant to 15 U.S.C. 61692 . COUNT II VIOLATION OF FLORIDA CONSUMER COLLECTION PRACTICES ACT (FCCPA), FLA. STAT. 559(P !" VI) BY DEFENDANTS CAPITAL ONE BAN# AND CAPITAL ONE SERVICES <=. Pa%a.%a)$s 0 t$%o(.$ 98 a%e %ealle.e" as t$o(.$ f(ll' set fo%t$ $e%ein. '5. Plainti(( is a consumer &it"in t"e meanin) o( t"e FCCPA, Fla. Stat. 6559.55(2). '6. *e(endant Ca#ital +ne 3an is a creditor &it"in t"e meanin) o( t"e FCCPA, Fla. Stat. 6559.55(') and *e(endant Ca#ital +ne Ser%ices is a de,t collector &it"in t"e meanin) o( t"e FCCPA, Fla. Stat. 6559.55(6). '4. !efen"ants Ca)ital One Ban* an" Ca)ital One Se%vi-es violate" t$e 1CCPA. !efen"antsF violations in-l("e, &(t a%e not li#ite" to, t$e follo+in./ (a) *e(endants Ca#ital +ne 3an and Ca#ital +ne Ser%ices %iolated Fla. Stat. 6448.@927) ,- disclosin) in(ormation concernin) t"e e1istence o( a de,t no&n to ,e reasona,l- dis#uted ,- t"e de,tor &it"out disclosin) t"at (act. (,)*e(endants Ca#ital +ne 3an and Ca#ital +ne Ser%ices %iolated Fla. Stat. 6448.@9283 &' -lai#in., atte#)tin. o% t$%eatenin. to enfo%-e a "e&t +$en s(-$ )e%son *no+s t$at t$e "e&t is not le.iti#ate. LHERE1ORE, Plaintiff "e#an"s ;(".#ent fo% "a#a.es a.ainst !efen"ants Ca#ital +ne 3an and Ca#ital +ne Se%vi-es (or a-t(al o% stat(to%' "a#a.es, an" )(nitive "a#a.es, atto%ne'Ms fees an" -osts, )(%s(ant to Fla. Stat. 6559.44. COUNT III VIOLATION OF FAIR CREDIT REPORTING ACT (FCRA), 15 U.S.C. 16$1 %ILLFUL NON&COMPLIANCE BY DEFENDANTS CAPITAL ONE BAN# AND CAPITAL ONE SERVICES <:. Pa%a.%a)$s 0 t$%o(.$ 98 a%e %ealle.e" as t$o(.$ f(ll' set fo%t$ $e%ein.

'9. Plainti(( is a consumer &it"in t"e meanin) o( t"e FC5A, 15 U.S.C. 616.1a(c). =A. !efen"ants Ca)ital One Ban* an" Ca)ital One Se%vi-es a%e f(%nis$e%s of info%#ation +it$in t$e #eanin. of t$e 1CRA, 04 5.S.C. 607:0s-9. =0. !efen"ants Ca)ital One Ban* an" Ca)ital One Se%vi-es +illf(ll' violate" t$e 1CRA. !efen"antsF violations in-l("e, &(t a%e not li#ite" to, t$e follo+in./ 2a3 !efen"ants Ca)ital One Ban* an" Ca)ital One Se%vi-es +illf(ll' violate" 04 5.S.C. 607:0s-92a32<3 &', if t$e -o#)leteness o% a--(%a-' of an' info%#ation f(%nis$e" &' an' )e%son to an' -ons(#e% %e)o%tin. a.en-' is "is)(te" to s(-$ )e%son &' a -ons(#e%, failin. to f(%nis$ t$e info%#ation to an' -ons(#e% %e)o%tin. a.en-' +it$o(t noti-e t$at s(-$ info%#ation is "is)(te" &' t$e -ons(#e%. 2&3 !efen"ants Ca)ital One Ban* an" Ca)ital One Se%vi-es +illf(ll' violate" 04 5.S.C. 607:0s-92&32032A3 &', afte% %e-eivin. noti-e )(%s(ant to 607:0i of a "is)(te +it$ %e.a%" to t$e -o#)leteness o% a--(%a-' of an' info%#ation )%ovi"e" &' a )e%son to a -ons(#e% %e)o%tin. a.en-', ne.li.entl' failin. to -on"(-t an investi.ation +it$ %es)e-t to t$e "is)(te" info%#ation. 2-3 !efen"ants Ca)ital One Ban* an" Ca)ital One Se%vi-es +illf(ll' violate" 04 5.S.C. 607:0s-92&32B3 &', afte% %e-eivin. noti-e )(%s(ant to 607:0i of a "is)(te +it$ %e.a%" to t$e -o#)leteness o% a--(%a-' of an' info%#ation )%ovi"e" &' a )e%son to a -ons(#e% %e)o%tin. a.en-', failin. to %evie+ all %elevant info%#ation )%ovi"e" &' t$e -ons(#e% %e)o%tin. a.en-ies. 2"3 !efen"ants Ca)ital One Ban* an" Ca)ital One Se%vi-es +illf(ll' violate" 04 5.S.C. 607:0s-92&32C3 &', afte% %e-eivin. noti-e )(%s(ant to 6 07:0i of a "is)(te +it$ %e.a%" to t$e -o#)leteness o% a--(%a-' of an' info%#ation )%ovi"e" &' a )e%son to a -ons(#e% %e)o%tin. a.en-', failin. to "i%e-t s(-$ -ons(#e% %e)o%tin. a.en-ies to "elete ina--(%ate info%#ation a&o(t t$e )laintiff )e%tainin. to t$e a--o(nt. LHERE1ORE, Plaintiff "e#an"s ;(".#ent fo% "a#a.es a.ainst !efen"ants Ca)ital One Ban* an" Ca)ital One Se%vi-es fo% a-t(al o% stat(to%' "a#a.es, an" )(nitive "a#a.es, atto%ne'Fs fees an" -osts, )(%s(ant to 04 5.S.C. 607:0n. COUNT IV VIOLATION OF FAIR CREDIT REPORTING ACT (FCRA), 15 U.S.C. 16$1 NEGLIGENT NON&COMPLIANCE BY DEFENDANTS CAPITAL ONE BAN# AND CAPITAL ONE SERVICES =9. Pa%a.%a)$s 0 t$%o(.$ 98 a%e %ealle.e" as t$o(.$ f(ll' set fo%t$ $e%ein. 6'. Plainti(( is a consumer &it"in t"e meanin) o( t"e FC5A, 15 U.S.C. 616.1a(c). ==. !efen"ants Ca)ital One Ban* an" Ca)ital One Se%vi-es a%e f(%nis$e%s of info%#ation +it$in t$e #eanin. of t$e 1CRA, 04 5.S.C. 607:0s-9.

=4. !efen"ants Ca)ital One Ban* an" Ca)ital One Se%vi-es ne.li.entl' violate" t$e 1CRA. !efen"antsF violations in-l("e, &(t a%e not li#ite" to, t$e follo+in./ (a) !efen"ants Ca)ital One Ban* an" Ca)ital One Se%vi-es ne.li.entl' violate" 04 5.S.C. 607:0s-92a32<3 &', if t$e -o#)leteness o% a--(%a-' of an' info%#ation f(%nis$e" &' an' )e%son to an' -ons(#e% %e)o%tin. a.en-' is "is)(te" to s(-$ )e%son &' a -ons(#e%, failin. to f(%nis$ t$e info%#ation to an' -ons(#e% %e)o%tin. a.en-' +it$o(t noti-e t$at s(-$ info%#ation is "is)(te" &' t$e -ons(#e%. 2&3 !efen"ants Ca)ital One Ban* an" Ca)ital One Se%vi-es ne.li.entl' violate" 04 5.S.C. 607:0s-92&32032A3 &', afte% %e-eivin. noti-e )(%s(ant to 607:0i of a "is)(te +it$ %e.a%" to t$e -o#)leteness o% a--(%a-' of an' info%#ation )%ovi"e" &' a )e%son to a -ons(#e% %e)o%tin. a.en-', ne.li.entl' failin. to -on"(-t an investi.ation +it$ %es)e-t to t$e "is)(te" info%#ation. 2-3 !efen"ants Ca)ital One Ban* an" Ca)ital One Se%vi-es ne.li.entl' violate" 04 5.S.C. 607:0s-92&32B3 &', afte% %e-eivin. noti-e )(%s(ant to 607:0i of a "is)(te +it$ %e.a%" to t$e -o#)leteness o% a--(%a-' of an' info%#ation )%ovi"e" &' a )e%son to a -ons(#e% %e)o%tin. a.en-', failin. to %evie+ all %elevant info%#ation )%ovi"e" &' t$e -ons(#e% %e)o%tin. a.en-ies. 2"3 !efen"ants Ca)ital One Ban* an" Ca)ital One Se%vi-es ne.li.entl' violate" 04 5.S.C. 607:0s-92&32C3 &', afte% %e-eivin. noti-e )(%s(ant to 607:0i of a "is)(te +it$ %e.a%" to t$e -o#)leteness o% a--(%a-' of an' info%#ation )%ovi"e" &' a )e%son to a -ons(#e% %e)o%tin. a.en-', failin. to "i%e-t s(-$ -ons(#e% %e)o%tin. a.en-ies to "elete ina--(%ate info%#ation a&o(t t$e )laintiff )e%tainin. to t$e a--o(nt. LHERE1ORE, Plaintiff "e#an"s ;(".#ent fo% "a#a.es a.ainst !efen"ants Ca)ital One Ban* an" Ca)ital One Se%vi-es fo% a-t(al "a#a.es, an" atto%ne'Fs fees an" -osts, )(%s(ant to 04 5.S.C. 607:0o. DEMAND FOR JURY TRIAL Plaintiff $e%e&' "e#an"s a t%ial &' ;(%' of all iss(es so t%ia&le as a #atte% of la+. !ate"/ 1e&%(a%' 90, 9AA: Res)e-tf(ll' s(&#itte",

[Na#e] [A""%ess] [P$one N]