To:

Lender 1
Lender 2
Lender 3

Prosecutor

Clerk of Court

NOTICE OF ACCEPTANCE OF THE CHARGES

Certified Mail/Confirmation of Delivery/Validation Notice # xxxx xxxx xxxx xxxx xxxx

Letter of Acceptance of the charges:

Mailed by: Susan Smith, Notary Public

Certified Mail/Confirmation of Delivery/Validation Notice # xxxx xxxx xxxx xxxx xxxx
[Address in brackets] [Zip code in brackets]

To: Dave Brown

At ABC Agency Address

NOTICE TO AGENT IS NOTICE TO PRINCIPAL

NOTICE TO PRINCIPAL IS NOTICE TO AGENT

Address

Date: ____________

RE: complaint on case # 123456 [PLAINTIFF] vs. JOHN H DOE

Dear [Judge’s name ex: James, Jones],

cc; [Prosecutor name]

Please take notice that I have accepted the presentment made by [name of prosecuting attorney]
to JOHN H DOE for assessed value and returned it to the presenter in exchange for closure and
settlement of case # 123456. I have exchanged my exemption for a discharge of the charges. I
enclosed an authorization for him to use my credit to discharge all court charges that may
apply. The instructions and a statement of account were attached. The Treasury has also been
notified that I am using my credit for this purpose.

The opposing parties have previously reached an agreement on the issues in the complaint.
There is no controversy. A copy of the relevant certificate is attached. I want settlement and
closure of this account immediately.

Sincerely,
Authorized Representative _____________________________

Attachments:
 Copy Authenticated Birth Certificate,
 Copy Redacted SS-5 Application,
 Copy Affidavit of Ownership,
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  Copy Affidavit of Ownership certified Mail Return Receipt (green card),
 Copy Birth Certificate CUSIP,
 Copy TITLE. Note: [You have to create the title. If you've got a title, i.e. a court case
(the case number is the title), Promissory Note (signature on the note is the title) you
don't have to create it.]

Autographed this day of month in the year 2019:

Autographed in the presence of:

Authorized Representative _____________________________

AFFIDAVIT/JURAT

This Affidavit/Jurat pertains to the foregoing page titled: "ACCEPTANCE OF CHARGES."

County _______________ )
) ss.
State_________________ )

I ________________________________, a Notary Public do verify by my autograph below,

that the man First-Middle: Last been known to and/or showing identification card with picture,
being picture I.D. That First-Middle: Last who now appears before me and autographed his
name on the preceding page in my presence and view, and did clearly state the following out
loud in living voice before me; "all statements in my foregoing pages are my truth, without
intent to mislead, and given on my unlimited liability, as my sworn testimony regarding
"ACKNOWLEDGEMENT OF DEBT."

Notary signature: ________________________

Notary printed name: _____________________

My commission expires___________________

These pages are the sole property of a natural man by the name First-Middle: Last.

Authorized Representative __________________________

Date: __________________________

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