Respondent's Private International Administrative Remedy Demand No.
RRK-040703-JG
Page - 1 of 13
April 7, 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-040703-JG
For: JOHN GREEN, COLLECTION MANAGER
ALLIANCE ONE
6565 KIMBALL DRIVE, SUITE 200
Via U.S.P.O. Registered Mail Article No.
GIG HARBOR, WASHINGTON 98335
RR463804212US
Re: Written communication from ALLIANCE ONE, hereinafter "Debt
Collector," dated
April 02, 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 JOHN GREEN, COLLECTION
MANAGER, 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. JOHN GREEN
and ALLIANCE ONE, 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, both JOHN GREEN and ALLIANCE ONE, hereinafter jointly
and severally referenced as "User" in this
paragraph, consent and agree 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 accoount-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 confimation 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 Practises 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 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 prvate capacity.
User, JOHN GREEN, tacitly consents and agrees that
JOHN GREEN 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: JOHN GREEN'S
bond; JOHN GREEN'S guarantor; any of JOHN GREEN'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
Seventh Day of the Fourth Month in the Year of Our
Lord Two Thousand Three by
and between the undersigned parties:
Debtor: JOHN GREEN
_________________________
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.
Alliance One communication dated April 2, 2003
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-040703-JG
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 defferent 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 Collextor purchase this alleged account from a previous
debt collector?
YES
NO N/A
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
negotation, 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 veifiable 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 chaarge-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:
Debi Buchanan, Notary Public
Post Office Box 835
Cave Junction, OR 97523
ATTACHMENTS: Copy of Published Copyright Notice
Copy of UCC Financing Statement
Collection letter from Alliance One dated April 2,
2003