Private

Non-negotiable <True_name>
In care of:
<True_Steet>
Near: <CityOnly>,
[<Post_Code>]
<CommonwealthRepublic>
Notice of Final Payment and Concurrent Billing Dispute Error Via
Private Administrative Remedy No. <TitleNo>

This Notice of Final Payment and Concurrent Billing Dispute Error Via Private Administrative Remedy No. <TitleNo> is binding
upon every principal and agent re the subject matter set forth herein below.

<Doc_Date> Sent Via U.S.P.S. Priority Mail, Delivery

Confirmation #
<Debt_CollectorCompany> _____________________<RegistredCertified_Mail
<Debt_CollectorUserAddress> _>
<Debt_CollectorUser_City_State_Zip>

Account # <Account_Number>

Final Payment

1. Thank you for accepting my final payment of twenty-five dollars ($25.00) as

consideration for this novation. Unless <Debt_CollectorCompany> hereinafter “DEBT
COLLECTOR” provides <True_name>, security party and principal entitlement holder, a
valid defense i.e. written dispute rejecting the above final payment within ten (10) days,
The Undersigned shall accept your tacit agreement all of the below described
facts/terms for accepting this final payment.

Billing Error Dispute

This Billing Error Dispute Notice establishes prima facie evidence as to the assertions made
herein, and is taken pursuant to the Truth in Lending Act & Fair Credit Billing Act, 15 USC
Sec. 1666 et seq. and Public Law 93-495 – October 28, 1974, and 12 CFR 226.13, et seq.

Important Notice
THIS IS NOT A REQUEST FOR COPIES OF MONTHY STATEMENTS OR A COPY OF A SIGNED
PROMISSORY NOTE. THIS IS A REQUEST THAT YOU MAKE APPROPRITE CORRECTION TO
THIS ACCOUNT, OR IN THE ALTERNATIVE, THAT YOU PROVIDE A COMPLETE WRITTEN
EXPLANATION IN THE NATURE OF A REPORT AS TO WHY YOU BELIEVE THAT THE STATED
BILLING ERROR IS INCORRECT (INCLUDING PRODUCTION OF DOCUMENTED “EVIDENCE”

Affidavit
2. The Undersigned Affiant, <True_name> hereinafter “Affiant”, having attained the age of
majority, competent to testify, does hereby solemnly state that the truths and facts
herein are of my own firsthand personal knowledge, and are true, correct, and
complete, certain and not misleading, so help me God.

Introductory Certification

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3. Affiant is of lawful age and competent to testify and has firsthand personal knowledge

of the facts stated herein.

Plain Statement of Facts

4. Be it known by this written communication that Affiant is in receipt of DEBT

COLLECTOR’S above-referenced billing statement dated October 5, 2003, hereinafter
“Written Communication,” attached herewith, made fully part of, and included herein by
reference.
5. Affiant, in addition to the above referenced notice of final payment is writing concerning
a billing error on Affiants Account.

6. DEBT COLLECTOR’S monthly statements are inaccurate for they should reflect a bank
liability (money owed to Affiant), and not a debt.
7. Affiant is hereby requesting that the error be corrected, and that any finance and other
charges related to the disputed amount be credited to properly reflect the transactions
that occurred irrespective of your acceptance of Affiant’s novation i.e. notice of final
payment “Accord and Satisfaction”.
8. This Billing Error is limited to DEBT COLLECTOR’S failure to credit Affiant’s account for
credits received, as explained herein, and is not to be construed as alleging anything
else.

Points & Authorities

9. Federal Reserve Bank of Chicago’s publication - Modern Money Mechanics, Page 6:

"Of course, they (the banks) do not really pay out loans from the money they receive
as deposits. If they did this, no additional money would be created. What they do
when they make loans is to accept promissory notes in exchange for credits to the
borrower's transaction accounts."
10.Account Ledger:
DEBT COLLECTOR accepted Affiant’s signed promise to pay, receipts, notes or other
similar instruments as bank money, creating and issuing new credits to Affiants
account that resulted in a bank liability (money owed to Affiant).
11.Payments to merchants and other financial institutions:
DEBT COLLECTOR used Affiant’s new credits to pay merchants or other financial
institutions for charges to the account.
12.Monthly Statements:
DEBT COLLECTOR failed to enter the new credits on Affiant’s monthly statements.
13.Additional Payments:
DEBT COLLECTOR received additional payments, interest and other finance fees,
which should have been posted as additional credits to the account, resulting in a
bank liability.

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 The error was not apparent in the monthly statements or otherwise disclosed to
Affiant, thus no notice was given. However, the statements are a reflection of an
underlying in-house error and thus subject to correction.
14.12 CFR 225. 13(a):

[X] The Billing Error stated herein represents: “(4) A reflection on a periodic
statement of the DEBT COLLECTOR'S failure to credit properly a payment or other
credit issued to the consumer's account; (5) A reflection on a periodic statement of a
computational or similar error of an accounting nature that is made by the DEBT
COLLECTOR; (6) A reflection on a periodic statement of an extension of credit for
which the consumer requests additional clarification, including documentation
evidence.”
15.POSTING DATE(S):

[X] All dates listed on the statements.

16. TRANSACTION DATE(S)

[X] All dates listed on the statements.

This Billing Error Dispute Does Not Involve:

• A complaint about alleged fraudulent and deceptive banking practices.

• A complaint about alleged claims regarding perpetration of fraud.
• A complaint about an unlawful extension of credit or creating credit instead of
money.
• A complaint about my legal obligation to pay back money owed.
• A complaint about fraudulent creation of the account or an invalid agreement.
• A complaint about whether I accepted the terms and conditions and benefited.
• A preconditioning of my obligation to repay the party that funded the capital for
money loaned.
17. ANY RESPONSES REGARDING THIS BILLING ERROR SHALL BE LIMITED TO THE ERROR(S)
ASSERTED AND MAY NOT EXTEND TO MATTERS WHICH THIS DISPUTE DOES NOT
INVOLVE.
Fair Credit Billing Act Requirements:

18. An acknowledgment of the dispute within ten (10) days. 15 USC Sec. 1666(a)(3)(A);
19. If the error is not corrected, a written explanation report following a reasonable
investigation, including the production of documentation evidence, within ninety (90)
days. 15 USC Sec. 1666(a)(3)(B)(ii); and
20. No restrictions or adverse actions on the account, pending resolution. 15 USC Sec.
1666(d).
Fair Credit Billing Act Violations: Failure to follow the rules pending resolution:

21.Relinquishment of the right to collect any alleged debt on the account. 12 CFR
226.13(d)(1);

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22. Exposure to liability for actual damages plus twice the amount of the finance charges.
15 USC Sec. 1640(a)(1)&(2); and;

23.Potential criminal liability for willful and knowing violation of the FCBA and other Truth in
Lending provisions. 15 USC Sec. 1611(1)&(3).
Conditions for Withdrawal of Dispute:

24. Affiant hereby states that this Billing Error Dispute shall be withdrawn if DEBT
COLLECTOR verifies the following statements under oath:
a. That DEBT COLLECTOR does NOT follow Generally Accepted Accounting
Principles hereinafter “GAAP”, or the Federal Reserve Bank’s policies and
procedures;
b. That DEBT COLLECTOR did not create any new credits from Affiant’s signed
promise to pay, receipts, notes or other similar instruments, and use said new
credit to pay for the charges to the account in question;
c. That DEBT COLLECTOR used their own assets or other depositor’s money to
fund the charges on the account;
d. That Affiant is not entitled to have the account credited for any form of
payment that they accept as money and/or assets under GAAP, or otherwise;
and
e. That the foregoing was disclosed to Affiant on a specific date in a document
that is attached and incorporated into the affidavit or oath.
25. Failure to verify the above five (5) statements under oath shall constitute additional
proof that the stated Billing Error is correct.

This Entire Agreement and Notice CONSTITUTES A NOTICE TO CEASE ALL

TELEPHONIC COMMUNICATION

Notice to Agent is Notice to Principle

Notice to Principle is Notice to Agent

25. Affiant hereby gives DEBT COLLECTOR notice that this written communication
constitutes express written notification that Affiant with full knowledge of the facts
stated herein, reserves and maintains all rights herein prescribed by Law, and with full
and complete disclosure hereby declares as fact:

(a) The above-referenced debt is subject to UCC § 3-311 Accord and Satisfaction by
Use of Instrument, House Joint Resolution 192 of June 5, 1933, Public Law 73-10
and Public Policy where it states in part: “Every obligation, heretofore or
hereafter incurred, whether or not any such provision is contained in or made
with respect thereto, shall be discharged upon payment, in any coin or currency
which at the time of payment, is legal tender for public and private debts..” This
is further codified at Uniform Commercial Code, hereinafter “UCC,” §§ 3-310(b),
311, 3-603(b);

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 (b) Guaranty Trust Co. of New York v. Henwood, et al, 307 U.S. 247 (1939), and
Chemical Bank & Trust Co. v. Same, states in part: “Analysis of the terms of the
Resolution (FN3) discloses, first, the Congress declared certain types of
contractual provisions against public policy in terms so broad as to include then
existing contracts, as well as those thereafter to be made. In addition, future use
of such proscribed provisions was expressly prohibited, whether actually
contained in an obligation payable in money of the United States or separately
'made with respect thereto.' This proscription embraced 'every provision'
purporting to give an obligee a right to require payment in (1) gold; (2) a
particular kind of coin or currency of the United States; or (3) in an amount of
United States money measured by gold or a particular kind of United States coin
or currency..”
“Having thus unmistakably stamped illegality upon both outstanding and future
contract and provisions designed to require payment by debtors in a frozen
money value rather than in a dollar of legal tender current at date of payment,
Congress-apparently to obviate any possible misunderstanding as to the breadth
of its objective-added, with studied precision, a catchall second sentence
sweeping ‘every obligation’, existing or future payable in money of the United
States,’ irrespective of ‘whether or not such provision is contained therein or
made with respect thereto.' The obligations hit at by Congress were those
'payable in money of the United States.' All such obligations were declared
dischargeable 'upon payment, dollar for dollar, in any coin or currency (of the
United States) which at the time of payment is legal tender for public and private
debts.” This U.S. Supreme Court ruling has not been over-turned, rescinded,
suspended, repealed, or amended;
(c) The entire taxing and monetary systems are under the Uniform Commercial Code
per The Federal Tax Lien Act of 1966, also cited as the Uniform Federal Lien
Registration Act;
(d) A check tendered in the amount of twenty-five ($25.00) dollars is attached hereto
is tendered pursuant to UCC § 3-11.

Tender of Surety Bond

26. Affiant, without waiver of any defense, and for the purpose of resolving this matter in
good faith, hereby offers as security a surety bond, attached hereto, as a remedy for
DEBT COLLECTOR in the event DEBT COLLECTOR is damaged as a result of Affiant’s
undertaking and execution of Affiant’s Private, Administrative Remedy.
27. Tender of this surety bond is in good faith, in the event DEBT COLLECTOR complies with
paragraph 23 of this document “Conditions for Withdrawal of Dispute”.
28. The time for DEBT COLLECTOR to respond or rebut this Notice of Final Payment and
Concurrent Billing Dispute Error as stated above, is set at ten (10) days, not including
day of service, and must be done in writing and any such communication must be
signed by a person under commercial liability under penalty of perjury. Any response
from DEBT COLLECTOR and likewise from DEBT COLLECTOR’S agent that is not
performed under commercial liability under penalty of perjury, and likewise an
incomplete response, shall constitute a dishonor by way of non-response and DEBT
COLLECTOR’S acceptance of Affiants instrument tendered as a “novation” (Accord and
Satisfaction).

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29. DEBT COLLECTOR tacitly consents and agrees to acknowledge Affiant’s full settlement
of the debt by providing Affiant with a completed DECLARATION OF SATISFIED or
CLOSED ACCOUNT in writing, attached herewith, within ten (10) days, not counting day
of service.
30. DEBT COLLECTOR tacitly consents and agrees, should DEBT COLLECTOR fail to fulfill
DEBT COLLECTOR’S legal/fiduciary responsibility in the time prescribed in within the
Billing Dispute Error that DEBT COLLECTOR thereby appoints Affiant as “Agent” for DEBT
COLLECTOR with specific Power of Attorney to address all negligence and violations that
may exist under state and federal law. Affiant shall exercise all rights and remedies
through the Specific Power of Attorney document attached herewith.
31. DEBT COLLECTOR tacitly consents and agrees that Affiant, as Agent under that certain
Specific Power of Attorney, is authorized to cure any fault/default arising from this
matter or matters related thereinafter. Specific Power of Attorney document is attached
herewith.
32. DEBT COLLECTOR tacitly consents and agrees that Affiant, as Agent under that certain
Specific Power of Attorney, is authorized to amend, append, correct, or repair the credit
files of Affiant with any and all credit reporting agencies, bureau’s, or organizations.
Specific Power of Attorney document is attached herewith.
33. DEBT COLLECTOR consents and agrees that DEBT COLLECTOR has a duty to prevent
this matter from damaging Affiant in both the public and private record. DEBT
COLLECTOR, in the event of a dishonor by way of non-response confesses judgment and
Affiant reserves the right to:
(a) Initiate a counterclaim against DEBT COLLECTOR;
(b) File a claim against the bond of any responsible party, including DEBT
COLLECTOR and all principals, agents, and assignees of DEBT COLLECTOR, whose
acts/omissions result in tort damages against Affiant.
34. Due process of law is guaranteed for Affiant at DEBT COLLECTOR’S Office of Risk
Management, and is codified at 18 USC §§ 1581, 242, 241, 4, at 15 USC § 1692, and
elsewhere.
Notice of Reservation of Right to Initiate a Counterclaim and File a Claim Against
Official Bond of <Debt_CollectorCompany>
35. If DEBT COLLECTOR, such as by commission, omission, and otherwise:
(a) Fails to respond or comply with Affiants Notice of Final Payment or Billing Dispute
Error.
(b) Fails to give Affiant full and complete disclosure with accompanying legal cites
re the rejection of Affiant’s Notice of Final Payment and or Billing Dispute Error by
a person under commercial liability under penalty of perjury.
(c) Makes any threat of action that cannot legally be taken, in violation of any
applicable law, such as the law codified at UCC § 3-311.
Affiant reserves the right to initiate a counterclaim/claim against the official bond of the
DEBT COLLECTOR, as well as the bond of any principal, agent, assignee, and the like, of
DEBT COLLECTOR, whose acts/omissions result in Affiant sustaining any tort injury.

36. DEBT COLLECTOR is also hereby given notice that:

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 (a) DEBT COLLECTOR’S unsubstantiated demands for payment (in “a particular kind
of coin or currency”) or in the alternative, further demands for payment after
acceptance of Affiants instrument tendered as a novation or failure to
acknowledge Affiants billing dispute error may be construed as a “scheme or
artifice” “caused to be delivered by mail” and may constitute mail fraud under
state and federal law (DEBT COLLECTOR may wish to consult competent legal
counsel before sending Affiant additional written communication);

37. DEBT COLLECTOR further consents and agrees that failure to produce a counter-affidavit
addressing each issue or material fact on its own merits point for point, that;
(a) DEBT COLLECTOR and its offices have yielded to Estoppel, Waiver, Fraud, nemo
debet bis vexari pro una et eadem Causa and DEBT COLLECTOR’S willful refusal
may subject DEBT COLLECTOR to civil liability/criminal punishment;
(b) DEBT COLLECTOR waives any and all claims against Affiant;
(c) DEBT COLLECTOR agrees to compensate Affiant for all costs, fees and expenses
incurred in defending against this and any and all damages re the above
referenced account; and
(d) DEBT COLLECTOR agrees to provide the books, records, ledgers, balance
sheets, and the like, at Affiant’s request for purpose of 1verification of proper
accounting re Affiant’s account per 15 USC § 1666.
38. DEBT COLLECTOR tacitly consents and agrees to bring forward a full assessment of all
monies, credit, or lawful tender in DEBT COLLECTOR’S possession, or posted to its
books, records, ledgers, balance sheets, and the like, that originated from Affiants wet-
ink signature or signature fixed by DEBT COLLECTOR on behalf of Affiant on any
application, document, or instrument.

39. DEBT COLLECTOR tacitly consents and agrees to remunerate, to Affiant, all monies,
credit, or lawful tender in DEBT COLLECTOR’S possession, or posted to its books,
records, ledgers, balance sheets, and the like, originating from Affiants wet-ink
signature or signature fixed by DEBT COLLECTOR on behalf of Affiant on any application,
document, or instrument.

40. DEBT COLLECTOR tacitly consents and agrees to provide Affiant with verification1
whereby DEBT COLLECTOR loaned DEBT COLLECTOR’S own assets, other depositor’s
funds, or DEBT COLLECTOR’S own credit to “fund’ the “loan” per the Fair Debt Collection
Practices Act.

41. DEBT COLLECTOR tacitly consents and agrees to provide Affiant with verification1
whereby DEBT COLLECTOR is the originator of the “loan” and that DEBT COLLECTOR did
not use Affiant’s good credit to create the funds for the “loan” per the Fair Debt
Collection Practices Act.

42. DEBT COLLECTOR tacitly consents and agrees to provide Affiant with verification1 where
DEBT COLLECTOR loaned substance or if Affiant provided the funds through Affiant’s
wet-ink signature on the promissory note to “fund” the “loan” per the Fair Debt
Collection Practices Act.

43. DEBT COLLECTOR tacitly consents and agrees to provide Affiant with verification1 to
determine whether the “loan” was posted as an asset and/or liability on any of DEBT
COLLECTOR’S books, records, ledgers, balance sheets, and the like per the Fair Debt
Collection Practices Act.
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44. DEBT COLLECTOR tacitly consents and agrees that any administrative payments,
overpayments, deposits, security deposits, and the like, made by Affiant shall not be
construed as acceptance of a certain “kind” or “specie” of payment required for the
proper settlement and/or discharge of the debt per House Joint Resolution 192 of June 5,
1933, Public Law 73-10, Public Policy, and Guaranty Trust Co. of New York v. Henwood,
et al, 307 U.S. 24.

45. DEBT COLLECTOR tacitly consents and agrees to refund any and all administrative
payments, overpayments, deposits, security deposits, and the like, made to DEBT
COLLECTOR prior to, or subsequent to, the submission of Affiant’s Instrument,
immediately upon receipt of written request from Affiant.

46. Any telephonic, electronic, facsimile communication received from DEBT COLLECTOR
may be used to support the basis of a case/counterclaim against DEBT COLLECTOR, and
likewise against DEBT COLLECTOR’S agents, and any information obtained in the course
of addressing claims/counter-claims such as by DEBT COLLECTOR’S commissions,
omissions, and the like, may be used for that purpose.

47. DEBT COLLECTOR tacitly consents and agrees that DEBT COLLECTOR has a duty to
prevent this matter from damaging Affiant in any way in both the public and private
record, and DEBT COLLECTOR further consents and agrees to correct all derogatory
reports made in both the public and private record that may have been issued by DEBT
COLLECTOR.

48. DEBT COLLECTOR further consents and agrees that DEBT COLLECTOR’S failure to
provide the requisite verification1 is a breach of contract creating fraud through material
misrepresentation which vitiates all forms, contracts, agreements, etc., expressed or
implied, from the beginning per UCC1-103.

49. DEBT COLLECTOR confesses judgment and Affiant reserves the right under the equal
protection of law to:
(a) Initiate a counterclaim against DEBT COLLECTOR;
(b) File a claim against the bond of any responsible party, including DEBT
COLLECTOR and all principals, agents, and assignees of DEBT COLLECTOR, whose
acts/omissions result in tort damages against Affiant.

50. DEBT COLLECTOR tacitly consents and agrees that DEBT COLLECTOR will provide
Affiant, upon receipt of Affiant’s written request, any and all information re DEBT
COLLECTOR’S bond which includes, but not limited to, DEBT COLLECTOR’S agent, surety
company, bond numbers, effective dates, and terms of the bond.

51. Due process of law is guaranteed both Affiant, and alleged debtor DEBT COLLECTOR’S
Office of Risk Management, and is codified at 18 USC §§ 1581, 242, 241, 4, at 15 USC §
1692, and elsewhere.
Verification

52. The Undersigned Affiant, <True_name>, does herewith swear, declare, and affirm that
Affiant issues this Affidavit with sincere intent, that Affiant is competent to state the
matters set forth herein, that the contents are true, correct, complete, and certain,
admissible as evidence, and reasonable and just in accordance with Affiant’s best
firsthand knowledge and understanding.
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________________________________________
<True_name>™, Affiant, Affiant Authorized Representative and Attorney in Fact for
<TRADENAME>™

Enclosures:
Notice of Final Payment
Billing Dispute Error
Surety Bond
Notice of Intent to Create and Execute Remedy
Specific Power of Attorney
Declaration of Satisfied & Closed Account
<Debt_CollectorCompany>’s Written Communication

Jurat

State of <StateOnly> )
) ss.
County of <CountyOnly> )

Subscribed and sworn to at _____________________ before me this _____ day of

________________, A.D. _____.
Notary public______________________________
My Commission Expires ______________________
WITNESS my hand and official seal.
_______________________________________________
Signature of Notary Public

SURETY BOND # <TitleNo>

I, <True_name>, hereinafter “The Undersigned” do hereby promise to pay “pledge” myself

as surety as follows:

Whereas: The Undersigned had brought forth an administrative remedy entitled “Notice of
Final Payment and Concurrent Billing Dispute Error via Private, Administrative Remedy #
<Misc_1> and;

Whereas: The Undersigned has requested specific performance from

<Debt_CollectorCompany> with respect to said administrative remedy and;

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Whereas The Undersigned shall create and execute the Undersigned remedy as described
in said Administrative Remedy in the event <Debt_CollectorCompany> fails to specifically
perform, respond or answer to The Undersigned Administrative Remedy and;

Whereas: The Undersigned has not been able to locate any lawful money of account in
circulation (Gold or Silver coin or bullion) in this State, and;

Whereas: Public Policy as established with House Joint Resolution 192 of June 5, 1933 states
in part:

That (a) Every provision contained in or made with respect to any

obligation which purports to give the obligee a right to require payment
in gold or a particular kind of coin or currency, or in an amount of money
of the United States measured thereby, is declared to be against public
policy; and no such provision shall be contained in or made with respect
to any obligation hereafter incurred. Every obligation, heretofore or
hereafter incurred, whether or not any such provision is contained
therein or made with respect thereto, shall be discharged upon payment,
dollar for dollar, in any coin or currency which at the time of payment is
legal tender for public and private debts. Any such provision contained in
any law authorizing obligations to be issued by or under authority of the
United States, is hereby repealed;

Now therefore and in consideration thereof, the Undersigned does hereby promise to pay,
i.e. undertakes to “bond”, <TRADENAME>’S action undertaken as a result of execution of
the remedies described in the undersigned’s Administrative Remedy in the following
amount: <Dollar_Amount> (<Dollar_Amount_Written>).

In the event that any person is damaged as a result of the Undersigned’s Private,
Administrative, Remedy # <TitleNo> and can demonstrate a bona fide claim of injury or
loss, the Undersigned shall discharge all obligations dollar for dollar by and through tender
of payment pursuant to public policy.

Dated the ________________ day of the ______________ month in the Year of Our Lord Two
Thousand Four

________________________________
<True_name>
In care of:
<True_Citystate_zip>
Near: <CityOnly>
[<Post_Code>]
<CommonwealthRepublic>

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 NOTICE OF INTENT TO CREATE AND EXECUTE REMEDY
THIS NOTICE IS BINDING UPON EVERY PRINCIPAL AND AGENT RE
THE SUBJECT MATTER SET FORTH HEREIN
The documents following this Notice of Intent to Create and Execute Remedy shall be used
by Affiant with impunity and without any certain recourse by DEBT COLLECTOR. Affiant
reserves the right to act as “Agent” under that certain Specific Power Of Attorney for DEBT
COLLECTOR should DEBT COLLECTOR fail to fulfill its fiduciary responsibility.
Affiant, without waiver of any defense, and for the purpose of resolving this matter in good
faith, herewith provides the:
(a) Declaration of Satisfied & Closed Account form, presented for DEBT COLLECTOR
to certify and upon which to apply DEBT COLLECTOR’S wet-ink signature and
deliver to Experian, Trans Union, and or Equifax hereinafter “Credit Reporting
Agencies” within the time period prescribed herein;
(b) Specific Power Of Attorney document fully prepared for DEBT COLLECTOR to
certify and upon which to apply DEBT COLLECTOR’S wet-ink signature, for DEBT
COLLECTOR to authorize Affiant to act on DEBT COLLECTOR’S behalf to execute
and perform the Declaration of Satisfied & Closed Account, in addition to any
substitutions, and the like, as well as terminating any judgments, liens, etc., at all
State, County, and Local offices, as the Affiant deems necessary.
Should DEBT COLLECTOR decline to so appoint Affiant by applying DEBT COLLECTOR’S own
wet-ink signature to the Declaration of Satisfied & Closed Account form and/or the Specific
Power of Attorney, both documents provided herewith, within the time period prescribed
herein, Affiant agrees to affix DEBT COLLECTOR’S signature to either, or both, documents
in accordance with Uniform Commercial Code, hereinafter “UCC,” §§ 1-201(39), 3-401(b)(ii).
DEBT COLLECTOR tacitly consents and agrees that DEBT COLLECTOR may violate, among
other, California Civil Codes and Federal Codes should DEBT COLLECTOR pursue legal
action against Affiant pursuant to Affiant acting as “Agent” under that certain Specific
Power Of Attorney for DEBT COLLECTOR where Affiant affixed DEBT COLLECTOR’S signature
and performed any actions such as the termination of any judgments, liens, etc., at all
State, County, and Local offices, performed by Affiant as “Agent”, that has been executed.

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 SPECIFIC POWER OF ATTORNEY
The Undersigned, <Debt_CollectorCompany>, residing at <Debt_CollectorUserAddress>,
<Debt_CollectorUser_City_State_Zip>, hereby appoints <True_name>™ of <True_Steet>,
<CityOnly>, <StateOnly> [<Post_Code>] Attorney-in-Fact, hereinafter "Agent."
If Agent is unable to serve for any reason, <Debt_CollectorCompany> designates
<FiduciaryAgent> of <Fiduciary_Address>, <Fiduciary_City_State>,
<Fiduciary_CommonwealthRepublic> [<Fiduciary_Post_Code>] as the Undersigned’s
successor Agent.
This Specific Power of Attorney is a self-executing agreement with
<Debt_CollectorCompany>’S signature affixed in accordance with UCC 3-401(b)(ii).
Authority is to be assumed upon proof of proper notice and <Debt_CollectorCompany>’S
non-response. Such action is to be construed as an endorsement of intent.
My Agent shall have full power and authority to act on my behalf. This power and authority
shall authorize my Agent to manage and conduct all of my affairs and to exercise all of my
legal rights and powers, including all rights and powers that I may acquire in the future. My
Agent's powers shall include, but not be limited to:
1. To prepare and record all necessary documents for proper transfer, release of all rights
and interest property via lien release to alleged debtor, <TRADENAME>.
2. To use any trademarks, service-marks, emblems, logos and the like for the purpose of
authenticating any document when acting on behalf of <Debt_CollectorCompany>.
3. To prepare and record any and all necessary documents with the Secretary of State,
County Recorder, State Court, Federal Court and or Credit Reporting Agencies
specifically related to account #<Account_Number>.
4. To prepare and record any and all necessary documents to amend, append, correct, or
repair any and all derogatory credit reports made against alleged debtor, on behalf of
<Debt_CollectorCompany>, which includes, but not be limited to: all credit reporting
agencies, all credit service bureau’s, and/or all credit reporting organizations, either
public or private.
Agent shall not be liable for any loss resulting from a judgment error made in good faith.
However, Agent shall be liable for willful misconduct, and likewise for failure to act in good
faith while acting under authority of this Specific Power of Attorney.
<Debt_CollectorCompany> authorizes Agent to indemnify and hold harmless any third
party who accepts and acts under this document.
Agent is entitled to reasonable compensation for any and all services provided while acting
in authorized capacity as agent of <Debt_CollectorCompany>. Agent is entitled to
reimbursement of all reasonable expenses incurred in connection with this Power of
Attorney.
Agent shall provide an accounting for all funds handled and all acts performed while acting
in authorized capacity as agent of <Debt_CollectorCompany> if
<Debt_CollectorCompany>, or any authorized personal representative or fiduciary of
<Debt_CollectorCompany>, so requests.

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This Specific Power of Attorney is effective ________________, 2004, and is not affected by
<Debt_CollectorCompany>’S disability or lack of mental competence, except as may
otherwise be provided by applicable statute. This Specific Power of Attorney shall continue
in effect for sixty (60) days from effective date, i.e. until _________________, ______. This
Specific Power of Attorney may be voided by DEBT COLLECTOR, or Agent, through the
proper execution of a Declaration of Satisfied & Closed Account, on or before the active
date. An additional sixty (60) days is granted to Agent to cure any matters that may arise
out of any action taken under this Specific Power of Attorney. The number of extensions of
“an additional sixty (60) days” needed to settle any and all matters arising thereinafter is
not set and is at the sole discretion of Agent.

<Debt_CollectorCompany>

<Debt_CollectorCompany>
[Signature affixed in accordance with UCC §§ 1-201(39), 3-401(b)(ii)]

<True_name>™/ Attorney-in-Fact/ Agent

ACKNOWLEDGEMENT
STATE OF <StateOnly> )
) ss.
COUNTY OF <CountyOnly> )

On this day, ______________ 2004, before me, a Notary Public, personally appeared
_______________________, personally known to me or has provided requisite proof as the
living soul whose name is subscribed to this instrument and acknowledged that he
executed the same.

Notary Signature (Seal)

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<Debt_CollectorCompany>
<Debt_CollectorUserAddress>
<Debt_CollectorUser_City_State_Zip>

Re:
<Military_Name>
<TRADE_Address>
<TRADE_City_State_Zip>, CA <Post_Code>

Account No: <Account_Number>

Social Security No. 123-45-6789

DECLARATION OF SATISFIED & CLOSED ACCOUNT

I, __________________________ being the duly authorized agent for <Debt_CollectorCompany>

do hereby declare and state that <TRADENAME> has satisfied the obligation in respect of
account number <Account_Number> in full. This declaration shall serve as notice to any
potential creditor or credit reporting agency that this account is closed.

Notice to credit reporting agencies:

Please update your files to reflect this account “paid as agreed”.

Printed name:
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___________________________________

Date:
___________________________________

APPOINTMENT OF THIRD PARTY WITNESS

In the event that DEBT COLLECTOR should ‘dishonor’ through non-response this Notice of
Final Payment and Concurrent Billing Dispute Error via Private, Administrative Remedy by
Tacit Procuration, all issues are deemed settled Stare Decisis DEBT COLLECTOR may not
argue, controvert, or otherwise protest the finality of the administrative findings in any
subsequent process, whether administrative or judicial.

Notice of Final Payment and Concurrent Billing Dispute Error via Private, Administrative
Remedy is dishonored. DEBT COLLECTOR further agrees to waive all rights to a trial before
a judge or jury, to observe this agreement and the arbitration Code of Procedure, and to
abide by and perform any award rendered by the Arbitrator(s) or a judgment entered by a
court having jurisdiction. In the event a court having jurisdiction finds any portion of this
agreement unenforceable, that portion shall not be effective and the remainder of the
agreement shall remain effective. This agreement shall be governed by and interpreted
under the Federal Arbitration Act, 9 U.S.C. Sections 1-16.

<True_name> grants DEBT COLLECTOR ten (10) days, exclusive of the day of receipt to
respond to the statements, claims, and demand above. Failure to respond will constitute as
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an operation of Law, the admission of DEBT COLLECTOR by tacit procuration to the
statement, claims and demands shall be deemed Res Judicata, Stare Decisis.

Responses must be sworn true, correct complete, and not misleading, the truth, the whole
truth, and nothing but the truth, and signed by a qualified authorized representative of
DEBT COLLECTOR. Failure to respond shall constitute an Estoppel by Acquiescence and
Judgment by Estoppel.

It is mandatory that if DEBT COLLECTOR responds to the foregoing it must be by delivering

any response to <True_name> via ‘Third Party Witness’ addressing <True_name> exactly
as shown below:

<True_name>
In care of: Third Party Witness
<FiduciaryAgent>
c/o <Fiduciary_Address>
<Fiduciary_City_State>, [<Fiduciary_Post_Code>]
<Fiduciary_CommonwealthRepublic>

If you have any further questions, please contact me in writing, via Third Party Witness, to
ensure you have no misunderstanding in this matter and all ledgering is handled
appropriately,

Thank you very much. I do look forward to your prompt response. Until then it is my
pleasure to be…

______________________________________
<True_name>™

PROOF OF SERVICE/MAILING AND WITNESS OF CONTENTS

Private Non
Negotiable

I, <FiduciaryAgent>, a third party, having no interest in the contents, or the proceeding

represented thereby, of the envelop in which the herein PROOF OF WITNESS OF
CONTENTS AND PROOF OF SERVICE is enclosed do hereby certify by my hand and
signature below that I have deposited the following documents contained within the

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same envelope containing the PROOF OF WITNESS OF CONTENTS AND PROOF OF
SERVICE and Mailing documents by United States Mail

• ‘Notice of Final Payment and Concurrent Billing Dispute Error via Private, Administrative
Remedy thirteen (13) pages in length, with __________ attachment pages, including this
proof of service.

The Proof of Service And Witness of Contents of Documents was deposited with the Untied
States Postal Service prepaid, was addressed upon and for and to the following
designations:

To: <Debt_CollectorCompany>
Attention: Billing Dispute Resolution Dept.
<Debt_CollectorCompany>
<Debt_CollectorUserAddress>, <Debt_CollectorUser_City_State_Zip>

I declare upon my own commercial liability under penalty of perjury under the laws of the
united States of America that the foregoing is true, correct, and complete.

Executed at ___________, <StateOnly> <FiduciaryAgent>

Dated: ___________________ ________________________

3rd Party Witness and Server

<FiduciaryAgent>
Third Party Witness
In care of:
<Fiduciary_Address>
<Fiduciary_City_State>,
[<Fiduciary_Post_Code>] <Fiduciary_CommonwealthRepublic>

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