1.

Non-Negotiable, Non-Transferable
NOTICE OF DISPUTE OF ALLEGED DET
!Insert Colle"tor#s Na$e %ere&
A''li"able to All S(""essors an)*or Assigns
+++++++++++++++++++++++++++++++++++++++++++++++++++++
Noti"e to t,e agent is noti"e to t,e 'rin"i'al an) noti"e to t,e 'rin"i'al is noti"e to t,e
agent
Date- .on)a/, 0an(ar/ 1, 1212
Fro$- !Insert 3o(r Na$e %ere&
To- !Insert Colle"tor#s Na$e&
P.O. o4 5555
Cit/, ST 6IP
7e- In t,e $atter of- Debt "olle"tion letter )ate) 11*18*1229: INSE7T NA.E OF
C7EDITO7, !;allege) "re)itor<&:
A""o(nt = 55555555555555
Sent b/- U.S. Postal Ser>i"e 7EGISTE7ED .AIL
To ?,o$ It .a/ Con"ern,
Please ta@e noti"e as folloAs-
1. A(t,orit/- T,at t,is Noti"e of Dis'(te of Allege) Debt !;Noti"e of Dis'(te<& is sent to
/o( '(rs(ant to Title 18, Unite) States Co)e Annotate) !;U.S.C.A<& B 1C91 et seD,
@noAn as t,e Fair Debt Colle"tion Pra"ti"es A"t !;FDCPA<&, t,e legislati>e '(r'ose of
A,i", is to 'rote"t "ons($ers fro$ ab(si>e, )e"e'ti>e, an) (nfair )ebt "olle"tion
'ra"ti"es b/ )ebt "olle"tors:
1. 3o(r )ebt "olle"tion letter- T,at I ,a>e re"ei>e) an) rea) /o(r )ebt "olle"tion letter
referen"e) abo>e, i)entif/ing /o(rself as )ebt "olle"tors,!E4,ibit A: "o'/ of )ebt
"olle"tion letter&, A,erein /o( allege t,at I ,a>e a )ebt obligation to t,e allege) "re)itor
referen"e) abo>e:
E. P(r'ose of t,is noti"e- T,at t,e '(r'ose of t,is Noti"e of Dis'(te is to assert $/ rig,ts
in )ebt "olle"tion (n)er FDCPA B 1C91!g&!b& Ait,o(t )ela/ an) Ait,in t,irt/ !E2& )a/s of
$/ re"ei't of /o(r aforesai) )ebt "olle"tion letter:
F. Allege) )ebt )is'(te)- T,at I ,ereb/ )is'(te t,e >ali)it/ of t,e allege) )ebt in its
entiret/:
8. Gerifie) )o"($entar/ e>i)en"e reD(este)- T,at I ,ereb/ reD(est /o( 'ro>i)e $e Ait,
t,e folloAing >erifie) !sAorn to b/ affi)a>it& )o"($entar/ e>i)en"e in s(bstantiation of
t,e allege) )ebt "lai$e) b/ t,e allege) "re)itor referen"e) in /o(r )ebt "olle"tion letter
!see E4,ibit A&:
!a& Proof of a(t,orit/- Please 'ro>i)e $e Ait, >erifie) !sAorn to b/ affi)a>it& 'roof of
/o(r a(t,orit/ to re'resent t,e allege) "re)itor in t,is instant $atter:
!b& 7eal 'art/ in interest- Please >erif/ A,o t,e real 'art/ in interest is in t,is )ebt
"olle"tion $atter:
!"& Allege) original "re)itor. Please 'ro>i)e $e Ait, t,e na$e an) a))ress of t,e allege)
original "re)itor if )ifferent fro$ t,e allege) "re)itor i)entifie) in /o(r abo>e $entione)
)ebt "olle"tion letter.
!)& Allege) original agree$ent- Please 'ro>i)e $e Ait, a >erifie) !sAorn to b/ affi)a>it&
"o'/, bot, front an) ba"@, of t,e allege) original agree$ent an) an/ ot,er allege)
original se"(rit/ instr($ents in t,eir entiret/, in"l()ing t,e allonge , affi4e) to t,e
original allege) agree$ent for en)orse$ents. Sai) affi)a>it is to be sAorn to be tr(e,
"orre"t, "o$'lete, an) not $islea)ing, b/ a 'ro'erl/ i)entifie) an) a(t,oriHe) offi"er of
t,e allege) "re)itor, A,o states t,at ,e or s,e ,as 'ersonal @noAle)ge !Fe)eral 7(les of
E>i)en"e I;F7E<J 7(le C21& of t,e >ali)it/ of sai) allege) original )o"($ent!s&.
!i& Ins'e"tion of )o"($ent!s&. Please 'ro>i)e $e Ait, t,e )ate, ti$e, an) 'la"e
"on>enient to !CIT3, STATE&, t,at I "an 'ersonall/ ins'e"t t,e abo>e allege) original
agree$ent an) an/ ot,er allege) original se"(rit/ instr($ents in t,eir entiret/ rele>ant to
t,e abo>e allege) )ebt.
!ii& C(sto)ian of )o"($ent!s&. Please 'ro>i)e $e Ait, t,e na$e, title, an) a))ress of t,e
nat(ral 'erson "(sto)ian of t,e allege) original agree$ent an) of an/ ot,er allege)
original se"(rit/ instr($ents.
!iii& A))ress of ',/si"al lo"ation of )o"($ent!s&. Please 'ro>i)e $e Ait, t,e a))ress of
t,e ',/si"al lo"ation of t,e allege) original agree$ent an) an/ ot,er allege) original
se"(rit/ instr($ents if )ifferent fro$ ;!ii&< abo>e.
!e& %ol)er in )(e "o(rse. Please 'ro>i)e $e Ait, >erifie) !sAorn to b/ affi)a>it& e>i)en"e
t,at t,e allege) "re)itor is t,e se"(re) 'art/ in t,e instant $atter, i.e., ,ol)er in )(e
"o(rse, an) ,as a 'erfe"te) se"(rit/ interest in t,e aforesai) allege) agree$ent an)
allege) )ebt:
!f& Proof of Gal(e Gi>en- Please 'ro>i)e $e Ait, >erifie) !sAorn to b/ affi)a>it& "o'ies,
bot, front an) ba"@, of all )o"($ents an) re"or)s Ait, res'e"t to t,e aforesai) allege)
agree$ent an) allege) )ebt fro$ t,e beginning, in"l()ing b(t not li$ite) to, an/ an) all
len)er iss(e) "an"elle) "ertifie) ",e"@s, "as,iers# ",e"@s, $one/ eD(i>alents or si$ilar
instr($ents, i)entifie) as or e>i)en"ing assets 'ro>i)e) b/ t,e allege) "re)itor an)*or t,e
allege) original "re)itor to $e an) in)orse) b/ $e:
!g& De'osit sli' an) "an"elle) ",e"@- Please 'ro>i)e $e Ait, a >erifie) !sAorn to b/
affi)a>it& "o'/ of t,e )e'osit sli' for t,e )e'osit of $/ allege) agree$ent in its entiret/
b/ t,e allege) "re)itor asso"iate) Ait, t,e abo>e allege) a""o(nt*file n($ber, an) a
>erifie) "o'/ of t,e "an"elle) ",e"@ iss(e) b/ t,e allege) "re)itor as 'a/or in 'a/$ent
for $/ allege) agree$ent in its entiret/ an) an/ ot,er allege) relate) se"(rit/
instr($ents:
!,& Affi)a>it of )ebt K )a$ages- Please 'ro>i)e $e Ait, an affi)a>it of )ebt an)
)a$ages in"(rre), sAorn to be tr(e, "orre"t, "o$'lete, an) not $islea)ing, b/ a 'ro'erl/
i)entifie) an) a(t,oriHe) offi"er of t,e allege) "re)itor, ,ereinafter ;affiant,< ('on ,is or
,er 'ersonal @noAle)ge !F7E 7(le C21& stating-
!i& t,at t,e allege) "re)itor is, in)ee), t,e se"(re) 'art/ an) ,ol)er in )(e "o(rse of t,e
aforesai) allege) original agree$ent in iss(e an) ,as an enfor"eable 'erfe"te) se"(rit/
interest t,erein '(rs(ant to an) in "o$'lian"e Ait, t,e Unifor$ Co$$er"ial Co)e
!;U.C.C.<& Se"tion 9-12E, Se"tion 9-12F!1&, an) Se"tion 9-E28, or eD(i>alent se"tions of
t,e Co$$er"ial Co)e of !INSE7T 3OU7 STATE %E7E&:
!ii& t,at t,e allege) "re)itor 'ro>i)e) "onsi)eration to $e, t,e allege) )ebtor, fro$ t,e
assets t,e/ ,a) on ,an) before t,e allege) "re)it Aas $a)e, an) in"(rre) a finan"ial loss
(n)er t,e f(ll an) "o$'lete allege) original agree$ent an) allege) )ebt, an) state ea",
an) e>er/ loss t,at t,e allege) "re)itor ,as in"(rre) to )ate (n)er t,e allege) )ebt in
iss(e: an)
!iii& t,at affiant ,as 'ersonal @noAle)ge !F7E 7(le C21& regar)ing t,e fa"ts of t,e allege)
)ebt an) is t,e original "(sto)ian of t,e boo@s of entr/, or )ire"tl/ s('er>ises sai)
original "(sto)ian of t,e re"or)s.
!i& oo@@ee'ing Lo(rnal * a""o(nt le)ger entries- Please 'ro>i)e $e Ait, a >erifie)
!sAorn to b/ affi)a>it& "o'/ of t,e "o$'lete set of original boo@@ee'ing Lo(rnal * a""o(nt
le)ger entries asso"iate) Ait, $/ allege) agree$ent an) allege) file*a""o(nt n($ber
(sing Generall/ A""e'te) A""o(nting Prin"i'les 'er 11 U.S.C. B 1ME1n, s,oAing all
)ebits an) "re)its an) i)entif/ing t,e so(r"e!s& an) a$o(nt of t,e "re)it f(n)s*assets:
Note- T,e >erif/ing affi)a>it of Lo(rnal * a""o(nt le)ger boo@@ee'ing entries is to be
"o$'lete) b/ t,e original "(sto)ian of t,e boo@s an) re"or)s, sAorn to be tr(e, "orre"t,
"o$'lete, an) not $islea)ing. F(rt,er, sai) affi)a>it s,all "ontain 'ositi>e i)entifi"ation
of t,e "(sto)ian, an) state t,at ,e or s,e ,as 'ersonal @noAle)ge !F7E 7(le C21& of sai)
entries.
!@& Assign$ent "ontra"t- If a''li"able, 'lease 'ro>i)e $e Ait, >erifie) !sAorn to b/
affi)a>it& 'roof of an assign$ent "ontra"t in its entiret/ of t,e allege) original agree$ent
an) t,e allege) )ebt in iss(e fro$ an allege) original "re)itor, as assignor, to t,e allege)
"re)itor, as assignee.
!l& Proof of a(t,orit/- Please 'ro>i)e $e Ait, a >erifie) !sAorn to b/ affi)a>it& "o'/ of
t,e "ontra"t /o(r fir$ ,as Ait, t,e allege) original "re)itor A,i", a(t,oriHes /o(r fir$ to
engage in "olle"tion a"ti>ities on t,eir be,alf against t,e abo>e allege) a""o(nt, an)
na$ing /o( as an a(t,oriHe) "olle"tion agent * "lai$s a)L(ster.
!$& Certifi"ation of a(t,orit/- Please 'ro>i)e $e Ait, a >erifie) !sAorn to b/ affi)a>it&
"ertifi"ate of a(t,orit/ fro$ t,e State of 55555555 a(t,oriHing /o(r "o$'an/ to
transa"t b(siness in t,e state of 55555555555 an) a ',oto"o'/ of /o(r State
De'art$ent of Co$$er"e an) Ins(ran"e "ertifi"ate.
!n& For$ 12E8- Please 'ro>i)e $e Ait, De'art$ent of t,e Treas(r/ For$ 12E8 C(sto)ian
of Do"($ents atta",e) or asso"iate) Ait, $/ allege) original agree$ent an) *or t,e
na$e an) a))ress of sai) "(sto)ian 'er ;!b&!ii&< abo>e:
!o& For$ 1299- Please 'ro>i)e $e Ait, De'art$ent of t,e Treas(r/ For$ 1299 Original
Iss(e Dis"o(nt for ea", /ear t,e allege) "re)itor Aas ,ol)er in 'ossession of t,e allege)
original agree$ent:
!'& Gen)or sales sli's*>o(",ers- Please 'ro>i)e $e Ait, >erifie) !sAorn to b/ affi)a>it&
"o'ies of all original sales sli's*>o(",ers fro$ all allege) >en)ors "o>ering all allege)
transa"tions in t,e abo>e referen"e) file*a""o(nt fro$ its in"e'tion to )ate.
Note- T,is Noti"e of Dis'(te is not a reD(est for "onfir$ation t,at /o( ,a>e $ere
',oto"o'ies of allege) )o"($ents. I a$ reD(esting ONL3 GE7IFIED DOCU.ENTA73
EGIDENCE in >ali)ation of t,e allege) )ebt '(rs(ant to t,e FDCPA.
C. ?arning- T,at all /o(r "o$$(ni"ations an) o$issions Aill be $a)e a 'art of an)
in"or'orate) into an/ litigation arising fro$ t,is $atter.
N. Ti$e is of t,e essen"e: re'l/ )ea)line- T,at ti$e is of t,e essen"e, t,erefore, I e4ten)
to /o(, 7ig,t?a/, t,irt/ !E2& )a/s fro$ t,e )ate of /o(r re"ei't of t,is Noti"e of Dis'(te
to 'erfor$ in "o$'lian"e Ait, >erif/ing t,e allege) )ebt as reD(este) abo>e 'er FDCPA
$an)ates. I Aill "onsi)er a reasonable e4tension of ti$eOonl/ for t,e 'ro)("tion of
>erifie) )o"($entsOs,o(l) /o( nee) $ore t,an t,e t,irt/ !E2& )a/s if /o( reD(est it in
Ariting to t,e a))ress beloA. 3o(r fail(re to 'erfor$ as ,erein reD(este) Aill s,oA ba)
fait, an) Aill establis, t,e fa"t t,at /o( are (sing ab(si>e, )e"e'ti>e, false, an) (nfair
"olle"tion ta"ti"s against $e as a "ons($er. F(rt,er$ore, if /o( re$ain silent to t,is
reD(est or are (nable to >erif/ t,e )ebt as abo>e, t,e legal "on"e'ts of esto''el b/
a"D(ies"en"e an) ta"it a)$ission Aill "o$e into 'la/ A,ereb/ t,e allege) )ebt Aill be
a)$itte) in>ali), a n(llit/, an) (nenfor"eable, an) t,ereb/ re'()iate) in its entiret/ ab
initio . In t,e interi$, /o( are 'ro,ibite) fro$ an/ "onta"t Ait, $e, t,e (n)ersigne),
e4"e't in Ariting, an) onl/ in regar)s to t,e $atters ,erein e4'resse). All )ebt "olle"tion
a"ti>it/O in"l()ing litigationO is to "ease 'er FDCPA B 1C91g!b& ;P t,e )ebt "olle"tor
s,all "ease "olle"tion of t,e )ebt, or an/ )is'(te) 'ortion t,ereof, (ntil t,e )ebt "olle"tor
obtains >erifi"ation of t,e )ebtP<
M. .an)ator/ re'l/ to (n)ersigne)- T,at all of t,e abo>e )e$an)e) >erifie) e>i)en"e,
sAorn to b/ a "o$'etent Aitness 'er F7E 7(le C21, s,o(l) be sent to $e, !INSE7T
3OU7 NA.E&, t,e (n)ersigne), as in)i"ate) at t,e a))ress beloA Ait,in t,e abo>e-
$entione) t,irt/ !E2& )a/s fro$ /o(r re"ei't of t,is Noti"e of Dis'(te. Please )o not sen)
an/ re'l/ "orres'on)en"e to $e at an/ ot,er $ail lo"ation e4"e't as folloAs-
Sen) to- 3OU7 NA.E
3OU7 ADD7ESS
CIT3, ST 44444
9. E4,ibits- All e4,ibits atta",e) to t,is Noti"e of Dis'(te are in"or'orate) b/ referen"e
,erein.
Signe) Ait, reser>ation of all rig,ts,
/- ++++++++++++++++++++++++++++++++++++++++
INSE7T 3OU7 NA.E
En"los(res- E4,ibit A O Co'/ of 44*44*1244 )ebt "olle"tion letter