September 29, 2003
Non-Negotiable In care of:
Post Office Box 1870
Cave Junction 97523
Oregon Republic
Raymond Ronald Karczewski©
RESPONDENT'S PRIVATE, INTERNATIONAL, ADMINISTRATIVE REMEDY
DEMAND NO. RRK-092903-GB
For: GARY BRANDT
CASE # 02 CR 0617
Trial Court Administrator
JOSEPHINE COUNTY COURTHOUSE
Via U.S.P.O. Registered Mail Article No.
GRANTS PASS OREGON, 97526
RR463870945US
Re: Written communication from GARY BRANDT, Trial Administrator,
hereinafter "Debt
Collector," dated September 24, 2003, a copy of which is attached herewith,
made fully part
hereof, and included herein by reference. NOTICE BY WRITTEN COMMUNICATION/SECURITY
AGREEMENT
This Notice by Written Communication/Security Agreement,
hereinafter "Notice by
Written Communication," provides GARY BRANDT, Trial Administrator,
hereinafter "User,"
notice that alleged debtor, i.e. "RAYMOND R. KARCZEWSKI," is
a common-law-
copyrighted trade name/trademark of Raymond Ronald Karczewski©,
hereinafter "Secured
Party," and that any unauthorized use of RAYMOND R. KARCZEWSKI©
by User constitutes
copyright/trade name/trade-mark infringement, and all such use
is strictly prohibited.
All rights reserved re common-law copyright of trade-name/trade-mark,
RAYMOND
RONALD KARCZEWSKI© -- as well as any and all
derivatives and variations in the
spelling of said trade-name/trade-mark -- Copyright © 2002
by Raymond Ronald Karczewski©.
Said trade-name/trade-mark, RAYMOND RONALD KARCZEWSKI©,
may neither be
used, nor reproduced, neither in whole nor in part, nor in any
manner whatsoever, without the
prior, express, written consent and acknowledgment of "Raymond
Ronald Karczewski" as
signified by the red-ink signature of Raymond Ronald Karczewski©,
hereinafter "Secured
Party."
With the intent of being contractually bound, any
juristic person, e.g. GARY
BRANDT, as well as any agent and any principal of said juristic
person, consents and agrees by
this Copyright Notice that neither said juristic person, nor
any agent, nor any principal of said
juristic person, shall display, nor otherwise use in any manner,
the common-law trade-
name/trade-mark RAYMOND RONALD KARCZEWSKI©, nor
any derivative of, nor any
variation in the spelling of, said trade-name/trade-mark, nor
the common-law copyright
described herein, without the prior, express, written consent
and acknowledgment of Secured
Party, as signified by Secured Party's signature in red ink.
Secured Party neither grants, nor
implies, nor otherwise gives consent for any unauthorized use
of RAYMOND R.
KARCZEWSKI©, and all such unauthorized use is
strictly prohibited. Secured Party is not
now, nor has Secured Party ever been, an accommodation party,
nor a surety, for the alleged
debtor, i.e. "RAYMOND R. KARCZEWSKI," nor for any derivative
of, nor for any variation in
the spelling of, said name, nor for any other juristic person,
and is so-indemnified and held
harmless by RAYMOND R. KARCZEWSKI© in Hold-harmless
and Indemnity Agreement
No. RRK-050302-HHIA dated the Third Day of the Fifth Month in
the Year of Our Lord
Two Thousand and Two against any and all claims, legal actions,
orders, warrants,
judgments, demands, liabilities, losses, depositions, summonses,
lawsuits, costs, fines, liens,
levies, penalties, damages, interests, and expenses whatsoever,
both absolute and contingent,
as are due and as might become due, now existing and as might
hereafter arise, and as
might be suffered by, imposed on, and incurred by RAYMOND R.
KARCZEWSKI© for
any and every reason, purpose, and cause whatsoever.
Self-executing Contract/Security Agreement in Event of
Unauthorized Use: By this
Notice by Written Communication, GARY BRANDT, hereinafter referenced
as "User" in
this paragraph, consents and agrees that any use of RAYMOND R.
KARCZEWSKI© other
than authorized use as set forth above constitutes unauthorized
use, counterfeiting, of Secured
Party's common-law-copyrighted property, contractually binds
User, renders this Notice by
Written Communication a Security Agreement, hereinafter "Security
Agreement," wherein User
is debtor and Raymond Ronald Karczewski© is Secured
Party, and signifies that User:
(1) grants Secured Party a security interest in all of User's
assets, land, and personal property
and all of User's interest in assets, land, and personal
property in the sum certain amount of
$500,000.00 per each occurrence of use of Secured Party's common-law-copyrighted
trade-
name/trade-mark, RAYMOND RONALD KARCZEWSKI©,
as well as for each and every use
of any and all derivatives of, and variations in the spelling
of, said common-law trade-
name/trade-mark, not excluding "Raymond Ronald Karczewski," plus
costs, plus triple
damages; (2) authenticates this Security Agreement wherein User
is debtor and Raymond
Ronald Karczewski© is Secured Party, and wherein
User pledges all of User's: assets, land,
motor vehicles; aircraft; vessels; ships; trademarks; copyrights;
patents; consumer goods;
firearms; farm products; inventory; equipment; money; investment
property; commercial
tort claims; letters of credit; letter-of-credit rights; chattel
paper; electronic chattel paper;
tangible chattel paper; certificated securities; uncertificated
securities; promissory notes;
payment intangibles; software; health-care-insurance receivables;
instruments; deposit
accounts; accounts; documents; livestock; real estate and real
property--including all buildings,
structures, fixtures, and appurtenances situated thereon, as
well as affixed thereto; fixtures;
manufactured homes; timber; crops; and as-extracted collateral,
i.e. all oil, gas, and other
minerals, as well as any and all accounts arising from the sale
of these substances, both at
wellhead and minehead; accessions, increases, and additions,
replacements of, and substitutions
for, any of the property described hereinabove in this paragraph;
products, produce, and
proceeds of any of the property described hereinabove in this
paragraph; accounts, general
intangibles, instruments, monies, payments, and contract rights,
and all other rights, arising out
of sale, lease, and other disposition of any of the property
described hereinabove in this
paragraph; proceeds, including insurance, bond, general intangibles,
and accounts proceeds,
from the sale, destruction, loss, and other disposition of any
of the property described
hereinabove in this paragraph; records and data involving any
of the property described
hereinabove in this paragraph, such as in the form of a writing,
photograph, microfilm,
microfiche, tape, electronic media, and the like, together with
all of User's right, title, and
interest in all computer software and hardware required for utilizing,
creating, maintaining, and
processing any such records and data in any electronic media,
and all of User's interest in all
such foregoing property in this paragraph, now owned and hereafter
acquired, now existing and
hereafter arising, and wherever located, as collateral for securing
User's contractual obligation
in favor of Secured Party for User's unauthorized use of Secured
Party's common-law-
copyrighted property; (3) consents and agrees that Secured Party
may file a UCC Financing
Statement wherein User is debtor and Raymond Ronald Karczewski©
is Secured Party; (4)
consents and agrees that said UCC Financing Statement described
above in paragraph "(3)" is
a continuing financing statement, and further consents and agrees
with Secured Party's filing of
any continuation statement necessary for maintaining Secured
Party's perfected security interest
in all of User's property and interest in property pledged as
collateral in Security Agreement as
described above in paragraph "(2)," until User's contractual
obligation theretofore incurred has
been fully satisfied; (5) authorizes Secured Party's filing of
any UCC Financing Statement, as
described above in paragraphs "(3)" and "(4)," and the filing
of any Security Agreement, as
described above in paragraph "(2)," in the UCC filing office;
(6) consents and agrees that
any and all such filings described in paragraphs "(4)" and "(5)"
above are not, and may not be
considered, bogus, and that User will not claim that any such
filing is bogus; (7) waives all
defenses; and (8) appoints Secured Party as Authorized Representative
for User, effective
upon User's default re User's contractual obligations in favor
of Secured Party as set forth
below under "Payment Terms" and "Default Terms" granting Secured
Party full authority and
power for engaging in any and all actions on behalf of User including,
but not limited by,
authentication of a record on behalf of User, as Secured Party,
in accordance with Secured
Party's sole discretion, deems appropriate, and, as regards any
deposit account of any kind
maintained with any bank in/under the name of User, and likewise
any deposit account
maintained with any bank in/under the Social Security Account
Number of User,
notwithstanding the absence of User's name as account-holder
on any such deposit account
maintained with any bank in/under the Social Security Account
Number of User, grants
Secured Party full authority and power for originating instructions
for said deposit-account
bank and directing the disposition of funds in said deposit account
by acting as signatory on
said deposit account without further consent of User and without
liability, and User further
consents and agrees that this appointment of secured Party as
Authorized Representative for
User, effective upon User's default, is irrevocable and coupled
with a security interest. User
further consents and agrees with all of the following additional
terms:
Payment Terms: In accordance with fees for unauthorized
use of RAYMOND R.
KARCZEWSKI© as set forth above, User hereby consents
and agrees that User shall pay
Secured Party all unauthorized-use fees in full within ten (10)
days of the date User is sent
Secured Party's invoice, hereinafter "Invoice," itemizing said
fees.
Default Terms: In event of non-payment in full of
all unauthorized-use fees by User within
ten (10) days of the date Invoice is sent, User shall be deemed
in default and (a) all of User's
property and interest in property pledged as collateral by User,
as set forth in above paragraph
"(2)," immediately becomes, i.e. is, property of Secured Party;
(b) Secured Party is appointed
User's Authorized Representative as set forth above in paragraph
"(8)"; and (c) User consents
and agrees that Secured Party may take possession of, as well
as otherwise dispose of in any
manner that Secured Party, in Secured Party's sole discretion,
deems appropriate, including, but
not limited by, sale at auction, at any time following User's
default, and without further notice,
any and all of User's former property and interest in property
formerly pledged as collateral by
User, described above in paragraph "(2)," now property of Secured
Party, in respect of this
Security Agreement, that Secured Party, again in Secured Party's
sole discretion, deems
appropriate.
Terms for Curing Default: In event of default
as set forth above under "Default Terms," User
can cure User's default and avoid strict foreclosure of any remainder
of User's former property
that is neither in the possession of Secured Party, nor otherwise
disposed of by Secured Party,
only by tendering payment within twenty (20) days of User's default
and only by payment in full
of the balance of the sun certain amount owed by User, as noticed
User in Invoice, that is not
already paid by Secured Party's possession, sale, liquidation,
and the like of User's former
property and interest in property pledged as collateral for securing
User's obligation.
Terms of Strict Foreclosure: User's non-payment in
full of all unauthorized-use fees
itemized in Invoice within said twenty- (20) day period for curing
default as set forth above
under "Terms for Curing Default" authorizes Secured Party's immediate
non-judicial strict
foreclosure on any and all remaining property and interest in
property formerly pledged as
collateral by User, now property of Secured Party, which is not
in the possession of, nor
otherwise disposed of by, Secured Party upon expiration of said
twenty- (20) day
default-curing period. Ownership subject to common-law
copyright and UCC Financing
Statement and Security Agreement filed with the UCC filing office.
Record Owner: Raymond
Ronald Karczewski©, Autograph Common Law Copyright
© 2002.
Should any provision of this Notice by Written Communication
be unenforceable, said
unenforceable provision is hereby severed from this Notice by
Written Communication, but
every remaining provision continues in full force and effect,
and this Notice by Written
Communication is deemed modified in a manner that renders this
Notice by Written
Communication in full force and effect. In all cases Secured
Party continues without liability
and is held harmless. Any prior communication, written
document, and the like by and
between User and Secured Party containing any mistake of Secured
Party is invalidated
thereby and of no force and effect, and may not be relied upon
by User against Secured
Party in this matter.
No consent of any kind is granted nor otherwise given re
any matter offered/alleged/asserted
by User and Secured Party withholds all consent. Secured
Party will consider granting
consent in favor of User only upon User's full disclosure of
any and all consequences of
any such granting of consent, accompanied by User's commensurate
attendant liability for
the veracity, relevance, and verifiability of any such disclosure,
which liability is borne by User
in the form of an authenticated Security Agreement, wherein User
is debtor and Raymond
Ronald Karczewski© is Secured Party, that self-executes
effective the moment of Secured
Party's confirmation of any material inconsistency/deviation/discrepancy
in the
aforementioned resultant consequences avowed by User, as determined
solely by Secured
Party in Secured Party's sole discretion.
Alleged debtor, i.e. RAYMOND R. KARCZEWSKI©,
does not take issue with the amount of
any alleged debt; rather, alleged debtor asserts that: the alleged
debt is not valid; Secured
Party holds a claim/security interest greater than any claim
alleged by User, a certified copy
of which UCC Financing Statement evidencing such supreme claim
and security interest is
attached herewith, made fully part hereof, and included herein
by reference; and, as stated
above, Secured Party is neither a surety, nor an accommodation
party, for alleged debtor, and
may not be construed as functioning in such capacity under any
circumstances.
Further, this is a request for validation of any alleged
debt and is not a request for a copy of
any invoice, statement, bill, agreement, alleged agreement, contract,
alleged contract, and the
like, nor is it a request for a copy of any notification of assignment,
negotiation/transfer of
rights, nor is it a request for a copy of any other un-verified
document/presentment referencing
said alleged debt. This request for validation of any alleged
debt is a request for bona fide
verification of any alleged debt.
In accordance with law, only duly sworn/affirmed affidavits,
oaths, and depositions qualify as
a verification of the lawful existence of a bona fide debt.
Absent such verification validating
the alleged debt, and absent proof of a claim greater than that
of Secured Party, User "fails
to state a claim upon which relief can be granted." Wherefore,
in accordance with the Fair
Debt Collection Practices Act, effective immediately upon User's
receipt of this Notice
by Written Communication, User must cease all collection/prosecution
efforts against alleged
debtor, Secured Party, and Secured Party's secured private property.
User is hereby notified of the following Privacy Act Notice:
Privacy Act Notice
This written Notice By Written Communication constitutes
User's due process notice and
opportunity for being heard. Absent compliance with all
requirements set forth herein User
is barred from using any defense of immunity from prosecution
for User's actions, as well as
the actions of User's agents.
By this Notice By Written Communication, User, as well
as User's agents and principals,
shall comply with the provisions of the Privacy Act of 1974,
as lawfully amended,
12 U.S.C. § 3401, the Right To Financial Privacy Act of
1978, as lawfully amended,
5 U.S.C. § 552a, and the Third Party Summons Act, special
procedures, 26 U.S.C. § 7609,
as lawfully amended, for assisting Secured Party in keeping inviolate
certain constitutionally
protected privacy rights.
By this Notice By Written Communication, User, as well
as User's agents and principals,
shall comply with this demand: User shall provide Secured
Party with a copy of any express,
written authorization from Secured Party whereby User is authorized
for
disclosing/revealing/divulging/sharing with any third-party,
in any manner, as well as by any
means of communication, any information, documentation, data,
property, effects, and the like
re alleged debtor, RAYMOND R. KARCZEWSKI©, and
likewise concerning Secured Party.
User's failure in providing said foregoing demanded authorization
constitutes admission by
User that User is in violation of the Privacy Act, as well as
other laws.
User possesses neither express, written authorization,
nor consent, from alleged debtor,
RAYMOND R. KARCZEWSKI©, nor Secured Party, for
using, revealing/disclosing/
divulging/sharing with any third party any secured information,
documentation, data, property,
effects, and the like of Secured Party.
This Notice By Written Communication is binding upon every principal
and agent re the
subject matter set forth herein, and each principal and each
agent is: (a) barred from providing
any Credit Reporting Agency any derogatory credit information
regarding the above alleged
debt; (b) prohibited from contacting alleged debtor by
mail, by telephone, as well as in person,
both at alleged debtor's residence, as well as at alleged debtor's
place of employment; and
(c) prohibited from contacting any other third party regarding
the above-referenced alleged
debt until User establishes the existence of a superior claim,
greater than that of Secured
Party's, and until said alleged debt is verified as indicated
above and alleged debtor is
provided with any such verification.
Note: the Fair Debt Collection Practices Act at 15 USC §
1692 et seq. states in relevant part
that: "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," as well as "the
threat to take any action that
cannot legally be taken," all of which constitute violations
of law. Therefore, User, as well as
any assignee, is prohibited from filing any lawsuit, notice of
lien, notice of levy, and the like, as
well as any other legal action against alleged debtor, as well
as against any of Secured Party's
secured private property, which is exempt from lien and exempt
from levy.
15 U.S.C. § 1692e(8) states: "Communicating or threatening
to communicate to any person
credit information which is known or which should be known to
be false, including the failure
to communicate that a disputed debt is disputed, is a violation
of § 1692e."
Further, User's above-referenced written communication,
if valid, constitutes an issue of
public currency, and, alleged debtor hereby requests from User,
in accordance with
the fundamental principals of American jurisprudence and law,
bona fide documentary
evidence that establishes the lawful basis for User's issue of
said public currency and User's
claim for payment of the alleged debt liability referenced within
User's written communication
issuing the public currency and stating the claim, i.e.: (a)
bona fide identification of any person
making request for payment by RAYMOND R. KARCZEWSKI©,
including a copy of said
person's bona fide, handwritten, legible, and notarized signature,
and the thumbprint, from
either hand, of said person making request for payment by RAYMOND
R. KARCZEWSKI©;
(b) bona fide evidence of any said person's authority for making
request for payment by
RAYMOND R. KARCZEWSKI©, if said person is acting
on behalf of another; and
(c) exhibition of the bona fide instrument, i.e., the bona fide
commercial contract bearing the
bona fide signature which supports User's demand for payment
of alleged debt by
RAYMOND R. KARCZEWSKI©, that, operating publicly,
establishes User's issue of
public currency, allegedly collectable from any of: (i) alleged
debtor; (ii) alleged debtor's
assets; (iii) Secured Party; (iv) Secured Party's secured private
property; and (d) positive
law in support of User's written attempt at collecting alleged
debt that, operating publicly,
establishes User's issue of public currency collectable from
any of: (i) alleged debtor;
(ii) alleged debtor's assets; (iii) Secured Party; (iv) Secured
Party's secured private property.
Alleged debtor and Secured Party can and will lawfully
construe User's failure re complying
with and satisfying essential requirements of the Fair Debt Collection
Practices Act and the
above four (4) requests, i.e. "(a)," "(b)," "(c)," and "(d)"
in the paragraph immediately above,
within a reasonable time, i.e. twenty-one (21) days, following
User's receipt of this written
communication, as User's self-invalidation of User's demand for
payment. Verification of
the alleged debt and satisfaction of the aforementioned four
(4) specific requests must be duly
sworn/affirmed in the form of one of the following: (a) affidavit;
(b) oath; (c) deposition.
Until the alleged debt is verified in accordance with the
Fair Debt Collection Practices Act
and said verification is sent alleged debtor and received by
alleged debtor, each and every
contact in violation of the Fair Debt Collection Practices Act
constitutes harassment and
defamation of character and makes User, as well as any and all
agents and principals who
take part in such harassment and defamation, a subject of liability
for damages, as well as
statutory damages, and legal fees, for each and every violation,
in private capacity.
User, GARY BRANDT, tacitly consents and agrees that GARY
BRANDT has a duty
for preventing this alleged account from damaging both alleged
debtor and Secured Party, and
further consents and agrees that alleged debtor and Secured Party
each reserve the right for
initiating a counterclaim, as well as a claim, against any of
the following: GARY BRANDT'S
bond; GARY BRANDT'S guarantor; any of GARY BRANDT'S principals,
agents, and
assignees whose act(s)/omission(s) results in either of the following:
(a) tort damages against
alleged debtor; (b) tort damages against Secured Party. Due process
of law is guaranteed both
alleged debtor and Secured Party at Debt Collector's Office of
Risk Management, and is
codified at 18 USC §§ 1581, 242, 241, 4, at 15 USC
§ 1692, and elsewhere.
The attached written communication is Respondent's response
re User's attempt, via written
communication, in collecting an alleged debt.
This Notice by Written Communication/Security Agreement
is herewith executed this
Twenty Ninth Day of the Ninth Month in the Year of Our Lord Two
Thousand Three by
and between the undersigned parties:
Debtor: GARY BRANDT
_________________________
Debtor's Signature
Secured Party accepts Debtor's signature in accord with UCC §§ 1-201(39), 3-401.
Secured Party: Raymond Ronald Karczewski©
___________________________________
Secured Party's Signature
Autograph Common Law Copyright ©
2002 by Raymond Ronald
Karczewski©. All Rights
Reserved. No part of this autograph
Common Law Copyright may be used, nor
reproduced in any manner,
without prior, express, written consent
and acknowledgment of
Secured Party as signified by Secured
Party's signature in red ink.
Unauthorized use of "Raymond Ronald
Karczewski" incurs same
unauthorized-use fees as those associated
with RAYMOND RONALD
KARCZEWSKI©, as set
forth above in paragraph "(1)" under
"Self-executing Contract/Security Agreement
in Event of
Unauthorized Use."
Enclosures: Published Copyright
Notice
UCC Financing
Statement.
Your letter
dated 9/24/03 reflecting debt of $914.00
AFFIDAVIT
Declarant/Affiant, Raymond Ronald Karczewski©,
Common Law trade-name/trademark,
copyright © 2002, a living, breathing, flesh-and-blood man, does
swear and affirm that
Declarant/Affiant has scribed and read the foregoing facts, and, in
accordance with the best of
Declarant/Affiant's firsthand knowledge and conviction, such are true,
correct, complete, and not
misleading, the truth, the whole truth, and nothing but the truth.
This Affidavit is dated the Twenty Ninth Day of the Ninth Month in the
Year of Our Lord Two
Thousand and Three
____________________________________________________________
Raymond Ronald Karczewski©, Secured Party/Creditor,
Declarant/Affiant
STATE OF OREGON
County of Josephine } ss.
BE IT REMEMBERED, That on this _______ day of ______________,
______,
Before me, the undersigned, A Notary Public in and for the State of
Oregon, personally
appeared the within named ______________________________________________
__________________________________________________________________
__________________________________________________________________
known to me to be the identical individual AS described
in and who executed the within instrument and
acknowledged to me that ___________ executed the same freely and voluntarily.
IN TESTIMONY WHEREOF, I have hereunto set My
hand And affixed my official seal the day
and Year last
above Written.
_________________________________________
Notary Public of Oregon
My Commission expires: _______________________
DEBT COLLECTOR DISCLOSURE STATEMENT
This statement and the answers contained herein may be used by Respondent,
if necessary, in any court of competent jurisdiction.
Respondent's Private International Administrative Remedy Demand No. RRK-092903-GB
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. 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
for entering 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:
(a) 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 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
DEPOSITION
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/service 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, in completing/answering
points "1"
through "44" above and returning this Debt Collector Disclosure Statement,
as well as
providing 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 be legally 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.
Mail recipient and address for return correspondence:
Raymond Ronald Karczewski©
c/o Post Office Box 1870
Cave Junction 97523
OREGON
ATTACHMENTS: Copy of Published Copyright Notice
Copy of UCC Financing Statement
Copy of your letter dated September 24, 2003 reflecting debt of $914.00
Copy of NOTICE OF ACCEPTANCE dated September 29, 2003