Posted for those who wish to use, not legal advice, just verfication of debt.
QUESTIONS TO ASK DEBT COLLECTOR WITH YOU DISPUTE THEIR CLAIM.
Debt collector name
Address
state
RE; Account
DEBT COLLECTOR DISCLOSURE STATEMENT
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 is not a substitute for, nor the equivalent of, the hereinabove-requested verification of the record, i.e. “Confirmation of correctness, truth, or authenticity, by affidavit, oath, or deposition” (Black’s Law Dictionary, Sixth Edition, 1990), re the alleged debt, and must be completed in accordance with the Fair Debt Collection Practices Act, 15 USC §1692g, 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 of Debt Collector: ……………………………………………………………….……………………………………………...
2.Address of Debt Collector: ……………………………………………….……………………………..…………………………….
3.Name of alleged Debtor: …………………………………………………………..………………………………………………….
4. Address of alleged Debtor: ……………….……………………………………...………………………………………………….. .
5. Alleged Account Number: ………..…………...……………………………………………………………………………………. ..
6.Alleged debt owed: $………………………………….……………………………………………………..……………………… ...
7.Date alleged debt became payable: ……...…………………………….………..……………..…..……………………………….
8.Re this alleged account, what is the name and address of the alleged Original Creditor, if different from Debt Collector?
…………………………………………………………………………………………………………………………………… ………
9. Re this alleged account, if Debt Collector is different from alleged Original Creditor, does Debt Collector have a bona fide affidavit of assignment to enter into alleged original contract between alleged Original Creditor and alleged Debtor?
YES NO
10. Did Debt Collector purchase this alleged account from the alleged Original Creditor? YES NO N/A (Not Applicable)
11. If applicable, date of purchase of this alleged account from alleged Original Creditor, and purchase amount:
Date: …………………………………………………… Amount: $……………………………………………..……………………
12.Did Debt Collector purchase this alleged account from a previous debt collector? YES NO N/A
13. If applicable, date of purchase of this alleged account from previous debt collector, and purchase amount:
Date: …………………………………………………… Amount: $……………………………………………..……………………
14. Regarding this alleged account, Debt Collector is currently the:
Owner; (b) Assignee; (c) Other – explain: …………………………………………………….… .
…………………………………………………………………………………………………………………………………… ………
15.What are the terms of the transfer of rights re this alleged account? ……….………….……….……………………………….
16. If applicable, transfer of rights re this alleged account was executed by the following method:
(a) Assignment; (b) Negotiation; (c) Novation; (d) Other – explain:…………………….…………………...……………
............………………………………………………………………………………………...…… …………………………………
17. If the transfer of rights re this alleged account was by assignment, was there consideration? YES NO N/A
18. What is the nature and cause of the consideration cited in # 17 above? ………………………….……….………..…………
………………………………………………………………………………………...…………………………………… ……………………………………………………………………………………………………...……………………… …………………………
19. If the transfer of rights re this alleged account was by negotiation, was the alleged account taken for value?
YES NO N/A
20.What is the nature and cause of any value cited in #19 above? ……………………….………………………………………...
…………………………………………………………………………………………………………………………………… ………
21.If the transfer of rights re this alleged account was by novation, was consent given by alleged Debtor? YES NO N/A
22. What is the nature and cause of any consent cited in #21 above? ………………………………………………………………
…………………………………………………………………………………………………………………………………… ………
23. 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
24. Date said verification cited above in # 23 was provided alleged Debtor: …………………………….………………………....
25. Was said verification cited above in # 23 in the form of a sworn or affirmed oath, affidavit, or deposition? YES NO
26. Verification cited above in # 23 was provided alleged Debtor in the form of: OATH AFFIDAVIT DEPOSTION
27. Does Debt Collector have knowledge of any claim(s)/defense(s) re this alleged account? YES NO
28. What is the nature and cause of any claim(s)/defense(s) re this alleged account? ……...…………………………………….
…………………………………………………………………………………………………………………………………… ………
29. Was alleged Debtor sold any products/services by Debt Collector? YES NO
30. What is the nature and cause of any products/services cited above in # 29? …….……………………………………………
…………………………………………………………………………………...……………………………...…… …………………
31. Does there exist a verifiable, bona fide, original commercial instrument between Debt Collector and alleged Debtor containing alleged Debtor’s bona fide signature? YES NO
32. What is the nature and cause of any verifiable commercial instrument cited above in # 31? .……………………………….
…………………………………………………………………………………...……………………………...…… …………………
33. Does there exist verifiable evidence of an exchange of a benefit or detriment between Debt Collector and alleged Debtor? YES NO
34. What is the nature and cause of this evidence of an exchange of a benefit or detriment as cited above in # 33? …………………………………………………………………………………...……………………………...…… ………………
35. Does any evidence exist of verifiable external act(s) giving the objective semblance of agreement between Debt Collector and alleged Debtor? YES NO
36. What is the nature and cause of any external act(s) giving the objective semblance of agreement from #35 above? …………………………………………………………………………………………………………………………………… ……
37. Have any charge-offs been made by any creditor or debt collector regarding this alleged account? YES NO
38. Have any insurance claims been made by any creditor or debt collector regarding this alleged account? YES NO
39. Have any tax write-offs been made by any creditor or debt collector regarding this alleged account? YES NO
40. Have any tax deductions been made by any creditor or debt collector regarding this alleged account? YES NO
41. Have any judgments been obtained by any creditor or debt collector regarding this alleged account? YES NO
42. At the time the alleged original contract was executed, were all parties apprised of the meaning of the terms and conditions of said alleged original contract? YES NO
43. At the time the alleged original contract was executed, were all parties advised of the importance of consulting a licensed legal professional before executing the alleged contract? YES NO
44. At the time the alleged original contract was executed, were all parties apprised that said alleged contract was a private credit instrument? YES NO
Debt Collector’s failure, both intentional and otherwise, to complete/answer points “1” through “44” above and return this Debt Collector Disclosure Statement, as well as provide Respondent with the requisite verification validating the hereinabove - referenced alleged debt, constitutes Debt Collector’s tacit agreement that Debt Collector has no verifiable, lawful, bona fide claim re the hereinabove-referenced alleged account, 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 re any and all collection attempts involving the hereinabove-referenced alleged account.
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.
____________________________________ ____________________________________
Date Printed name of Signatory
____________________________________ ____________________________________
Official Title of Signatory Authorized Signature for Debt Collector
Debt Collector must timely complete and return this Debt Collector Disclosure Statement, along with all required documents referenced in said Debt Collector Disclosure Statement. 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, which specifically includes the requisite verification, made in accordance with law and codified in the Fair Debt Collection Practices Act at 15 USC §1692 et seq., and which states in relevant part: “A debt collector may not use any false, deceptive, or misleading representation or means in connection with the collection of any debt,” which includes “the false representation of the character, or legal status of any debt,” and “the threat to take any action that cannot legally be taken,” all of which are violations of law. If Debt Collector does not respond as required by law, Debt Collector’s claim will not be considered and Debt Collector may be liable for damages for any continued collection efforts, as well as any other injury sustained by Respondent. Please allow thirty (30) days for processing after Respondent’s receipt of Debt Collector’s response.
Recording Requested by, and
When Recorded Return to:
Your name
Address
State and zip code
__________________________________________
Cc:file
For more information about this, please see here.
Linear Mode
