DEBT COLLECTOR DISCLOSURE STATEMENT Notice to Agent is Notice to Principal ~ Notice to Principal is Notice to Agent NOTICE: THIS DOCUMENT

IS NOT INTENDED TO THREATEN, HARASS, HINDER OR OBSTRUCT ANY LAWFUL OPERATIONS. IT IS FOR THE PURPOSES OF OBTAINING LAWFUL REMEDY AS IS PROVIDED BY LAW. September 2, 2010 Respondent: Donald Duck 123 Main St Anaheim, California 92801 Debt Collector: Via Certified Mail Receipt

LIE, CHEATUM AND BEATUM 2151 SALVIO STREET SUITE W CONCORD, CA 94520 RE: ACCOUNT #123455 / ORIGINAL CREDITOR – BANK OF BS To whom it may concern: This statement and the answers contained herein may be used by Respondent, if necessary, in any court of competent jurisdiction. Notice: This Debt Collector Disclosure Statement must be completed in accordance with the Fair Debt Collection Practices Act, 15 USC §1692g, Title VIII Debt Collection Practices, § 809 of the Federal Trade Commission, applicable portions of Truth in Lending (Regulation Z), 12 CFR 226, and demands as cited above Disputed Debt. Debt Collector must make all required disclosures clearly and conspicuously in writing re the following: 1.Name / Address of Debt Collector: ___________________________________________________________________________________ 2. Name / Address of Alleged Debtor: ___________________________________________________________________________________ 3. Alleged Account Number: _______________________________________________________ 4. Alleged debt owed : $ __________________________________________________

Has the Statute of Limitations expired on this debt? YES NO YES NO 16. If applicable.5. date of purchase of this alleged account from alleged Original Creditor. if Debt Collector is different from alleged Original Creditor. Regarding this alleged account. and purchase amount: Date:__________________________ Amount: $__________________________________ 10. Have any insurance claims been made by any creditor or debt collector regarding this alleged account? YES YES NO 18. if different from Debt Collector? ___________________________________________________________________________________ 7. (b) Assignee. date of purchase of this alleged account from previous debt collector. Have any charge-offs been made by any creditor or debt collector regarding this alleged account? . affidavit.Did Debt Collector purchase this alleged account from a previous debt collector? YES N/A 11. Have any tax write-offs been made by any creditor or debt collector regarding this alleged account? NO NO 19. Date said verification cited above in # 13 was provided alleged Debtor: ______________________ 15. Has Debt Collector provided alleged Debtor with the requisite verification of the alleged debt as required by the Fair Debt Collection Practices Act? YES NO 14. Was said verification cited above in #13 in the form of a sworn or affirmed oath. If applicable. Re this alleged account. Did Debt Collector purchase this alleged account from the alleged Original Creditor? YES 12. Name / Address of alleged Original Creditor. or deposition? YES NO 17. Have any tax deductions been made by any creditor or debt collector regarding this alleged account? YES 20. does Debt Collector have a bona fide affidavit of assignment to enter into alleged original contract between alleged Original Creditor and alleged Debtor? YES N/A (Not Applicable) 9. and purchase amount: Date:_____________________ Amount: $_________________________________ NO NO NO 8. Debt Collector is currently the: Owner. (c) Other – explain:_________________________________________________ 13. Date alleged debt became payable: __________________________________________ 6.

” all of which are violations of law. made in accordance with law and codified in the Fair Debt Collection Practices Act at 15 USC §1692 et seq.” which includes “the false representation of the character. Failure to complete and return this Debt Collector Disclosure Statement shall acknowledge the debt uncollectable and deleted with all major credit bureaus. If Debt Collector does not respond as required by law. lawful.. 411 (1908).Debt Collector’s failure. Co. Sincerely. as well as any other injury sustained by Respondent. in making a payment. along with all required documents referenced in said Debt Collector Disclosure Statement. Parties may be considered volunteers if.referenced alleged debt. Declaration: The Undersigned hereby declares under penalty of perjury of the laws of this State that the statements made in this Debt Collector Disclosure Statement are true and correct in accordance with the Undersigned’s best firsthand knowledge and belief. Norfolk & Dedham Fire Ins. Smith v. 298. Co. Debt Collector’s failure to respond as requested in full and completely shall also prohibit any further collection activities." Laffranchini. to complete/answer points “1” through “20” above and return this Debt Collector Disclosure Statement. 318 A. Aetna Casualty & Surety Co. or misleading representation or means in connection with the collection of any debt. Rptr. and that Debt Collector tacitly agrees that Debt Collector waives all claims against Respondent and indemnifies and holds Respondent harmless against any and all costs and fees heretofore and hereafter incurred and related regarding any and all collection attempts involving the hereinabove-referenced alleged account.” and “the threat to take any action that cannot legally be taken. 153 P. 208 U. . Please allow thirty (30) days for processing after Respondent’s receipt of Debt Collector’s response. Your Name Here A volunteer. and which states in relevant part: “A debt collector may not use any false. 344. App. 132 Vt. or intermeddler is "one who thrusts himself into a situation on his own initiative. stranger. Henningsen v. they act without any obligation. legal or moral. & Loan Ass'n. and not one who becomes a party to a transaction upon the urgent petition of a person who is vitally interested. and they act without being requested to do so by the person liable on the original obligation. or legal status of any debt. including transfer or selling of this debt to successor assignees. bona fide claim regarding the hereinabove-referenced alleged account. v.. they have no interest of their own to protect. and whose rights would be sacrificed did he not respond to the importunate appeal. as well as provide Respondent with the requisite verification validating the hereinabove . deceptive. Debt Collector’s claim will not be considered if any portion of this Debt Collector Disclosure Statement is not completed and timely returned with all required documents.2d 659. 3d 1092.S. which specifically includes the requisite verification. both intentional and otherwise. ____________________________________ ____________________________________ Date Printed name of Signatory ____________________________________ ____________________________________ Official Title of Signatory / Authorized Signature for Debt Collector /Must be notarized Debt Collector must timely complete and return this Debt Collector Disclosure Statement.. 1098. State Sav. 175 Cal. constitutes Debt Collector’s tacit agreement that Debt Collector has no verifiable. 39 Nev. 404. 223 Cal. Debt Collector’s claim will not be considered and Debt Collector may be liable for damages for any continued collection efforts. 48. You should also be aware that sending unsubstantiated demands for payment through the United States Mail System might constitute mail fraud under federal and state law. 341. United States Fidelity Guar. 301 (1986). 661 (1974). at 252.

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