[quasimodo]

(second document)

NON-NEGOTIABLE NOTICE TO COMPLETE IN FULL
DEBT COLLECTOR DISCLOSURE STATEMENT
NOT AN OFFER. ALL RIGHTS/DEFENSES RESERVED. RIGHT TO REJECT ANY AND ALL BIDS OF PRIVATE SETTLEMENT RESERVED.
authorized representative not accountable for errors and omission of the offerror and offerror’s partners, known and unknown

(This statement and the answers contained herein may be used in any court of competent jurisdiction.)
Secured Party’s Private International Administrative Remedy Demand
Respondent:_______________________________________ __________
NOTICE: In accordance with the Fair Debt Collection Practices Act, 15 USC §1692g and the Fair Credit Reporting Act, WHATEVER MORTGAGE CO P.O. Box 1234 SOMEWHEREVILLE, STATE 51515-1234 must send completed Debt Collector Disclosure Statement with verification, i.e., “Confirmation of correctness, truth, or authenticity, by affidavit, oath, or deposition” (Black’s Law Dictionary, Sixth Edition), of the records regarding each of the following questions with-in thirty (30) days of certified mailed receipt of this legally binding document between Quasimodo and WHATEVER MORTGAGE CO. P.O. Box 1234 SOMEWHEREVILLE, STATE 51515-1234
:
1. Name of Debt Collector:

2. Address of Debt Collector:

3. Amount of debt reported by Debt Collector:

4. Did Debt Collector purchase this account from the original creditor?
YES
NO
5. Date of purchase from original creditor and purchase amount:
Date:________________________

Amount:$_______________________
6. Did Debt Collector purchase this account from a previous debt collector?
YES
NO