NOTICE
DEMAND FOR VALIDATION AND PROOF OF CLAIM
Date: 9/11/2020
From:
First-Middle: Last
c/o Street Address.
City, State.
U.S.A. Near. [XXXXX-9998]
Non-Domestic/Non-Resident Mail
Hereinafter collectively referred to as “Claimant”.
To:
FU-Q-PAE-MI COLLECTION AGENCY, INC.
STREET ADDRESS
CITY, STATE ZIP
CERTIFIED MAIL RECEIPT #: XXXX-XXXX-XXXX-XXXX-XXXX-XX
Hereinafter collectively referred to as "RESPONDENT", "you", "your company".
Re: Alleged Original Creditor: NAME OF ORIGINAL CREDITOR
Alleged Account: XXXXXXX
Alleged Debt Amount: $000.00
To Whom it May Concern,
This letter is in response to a letter received by your company on September 2, 2020. What I
would first like to know is who are you? It would appear as though [ORIGINAL CREDITOR]
has sold this account to you, a 3 rd party interloper, and you may be participating in fraud. Since
there is no signature on the documents you may have sent me, who is accountable for this
contract I am being offered? If you can state your claim & provide that contract I have with you
whereas there is a wet ink signature from the Claimant & someone From the RESPONDENT, I
would be happy to settle this alleged account.
Please notice that this is a request for VALIDATION and PROOF OF CLAIM made pursuant to
the Fair Debt Collection Practices Act and Fair Credit Billing Act. I respectfully request that
your offices provide Claimant with competent evidence as per the attached “Declaration and
Proof of Claim” that I have any legal obligation to pay you the unsubstantiated alleged debt.
At this time please be informed that if your offices have reported non-validated information to
any of the 3 major Credit Bureaus, such as, Equifax, Experian and TransUnion prior to validation
and proof of claim of the alleged debt, this action could constitute fraud under both Federal and
State Laws.
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Due to this fact, if any negative mark is found on any of Claimant's credit reports by your
company or any company that you represent, I may further explore options regarding action
against you and anyone you represent, in accordance with Violation of the Fair Credit Reporting
Act, as well as Violation of the Fair Debt Collection Practices Act, and United States Code
TITLE 18, CHAPTER 63, Sec. 1341.
Until such time that your offices provide Claimant with proof of claim of the alleged debt, the
alleged debt is considered to be invalid, and any documents that you might send me will be
returned to you as ‘refused for cause without dishonor upon proof of claim’. Your offices have
thirty (30) days to produce the required documentation in accordance with FTC guidelines.
During this validation period and proof of claim, if any action is taken which could be
considered detrimental in any way to Claimant’s private commercial affairs and/or credit reports,
said action will be considered a “dishonor” and cause the self-executing contract portion of this
notice to be implemented. This includes the listing of any information to a credit-reporting
repository that could be inaccurate or invalid.
If you can state your claim, please provide that information & fill out the enclosed IRS form W9.
I will need your EIN number to forward to IRS for collections via form 1099/1096 stating your
taxable gain on any payments made or amounts you may incur in the self-executing contract
section if you pursue this matter without proof of claim.
When you fill out the proof of claim document attached, please note that only signed, sworn
statements in affidavit form, oath or jurat with the wet ink signature of the real party in interest,
as described in Rule 17 of the Federal Rules of Civil Procedure will be accepted, any others
would be considered frivolous, non-truths, and unlawful responses.
If your offices fail to respond to this validation and proof of claim request within thirty (30) days
from the date of your receipt, all references to this account must be deleted and completely
removed from Claimant's credit file and a copy of such deletion request shall be sent to Claimant
immediately.
Counter Claim with Self-executing Contract
If Respondent, such as by commission, omission, and/or otherwise:
Fails to provide VALIDATION and PROOF OF CLAIM within thirty (30) days;
Makes a false representation of the character of the hereinabove-referenced alleged debt;
Makes a false representation of the legal status of the hereinabove-referenced alleged debt;
Makes any threat of action that cannot legally be taken, in violation of any applicable law, such
as, the law codified at the Fair Debt Collection Practices Act, such commission, omission, and
/or otherwise will be construed to be Respondent’s tacit acceptance of the terms and conditions
stated herein. In which case RESPONDENT agrees to the following:
Voluntarily waiving all claims against Claimant, their Agent or Heirs with prejudice; and,
The matter regarding the alleged debt is finally and totally settled; and,
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Voluntarily admits the Claimant is the depositor for this account, that Respondent risked none of
their assets at any time regarding this account and that they failed to disclose these material facts
to Claimant; and, voluntarily report the date of last activity on this account is the date of this
notice.
Furthermore, RESPONDENT’S failure to “Cease and Desist” in accordance with the
requirements of the FDCPA and other related law, and/or satisfy the above “terms and
conditions,” constitutes RESPONDENT’S “Breach of Duty” and voluntary agreement to
compensate Claimant, by certified mail, with a cashier’s check within ten (10) days of the date of
notice by Claimant, their Agent or Heirs, in the following amounts:
One Thousand Dollars ($1,000.00) for each communication made to Claimant or their Agent or
Heirs, whether telephonically or in writing, which is not in affidavit form, by a man or woman
who has first-hand knowledge, regarding Respondent’s unsubstantiated claim; and, One
Thousand Dollars ($1,000.00) for each court appearance Claimant, their Agent or Heirs makes in
response to Respondent’s unsubstantiated claims; and, One Thousand Dollars ($1,000.00) per
occurrence, for listing or reporting any information to a credit reporting repository which could
be considered detrimental to Claimant’s credit history; and, Debt Collector tacitly agrees that
Debt Collector will compensate Respondent for all costs; fees and expenses incurred in
defending against this and any and all continued collection attempts re: the above-referenced
alleged account.
This is a private communication and is intended to affect an out-of-court settlement of this
matter. Conduct yourself accordingly. Should any provision on this agreement be found to not
be enforceable by order of a court of competent jurisdiction, it shall not adversely affect any
other provision of this agreement and reasonable opportunity and effort shall be taken to modify
it to become enforceable.
NOTICE TO THE PRINCIPAL IS NOTICE TO THE AGENT.
NOTICE TO THE AGENT IS NOTICE TO THE PRINCIPAL.
Applicable to all successors and assigns.
Silence is Acquiescence/Agreement/Dishonor.
Executed on this _____ day of _____________, 2020.
By: _______________RED THUMB_____
First-Middle: Last, sui juris.
Authorized Representative for ALL-CAPS NAME.
CC Federal Trade Commission
Consumer Complaint
600 Pennsylvania Avenue, NW
Washington, DC 20580
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CC [STATE OF ] DEPARTMENT OF JUSTICE
Name, Attorney General
Street address
City, State ZIP- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
CREDITOR/DEBT COLLECTOR DECLARATION and PROOF OF CLAIM
Please provide all of the following information and submit the appropriate forms and
paperwork back to me along with the Affidavit signed In Accordance with 28 U.S.C.
Section 1746 within 30 days from the date of your receipt of this request for validation and
proof of claim.
1. Alleged Name and Address of Creditor:
2. Name on File of Alleged Debtor:
3. Alleged Account #:
4. Amount of alleged debt:
5. Date that this alleged debt became payable:
6. Date of original charge off or delinquency:
7. Amount paid if debt was purchased:
8. Please attach a copy of any signed agreement debtor has made with debt collector, or
other verifiable proof that debtor has a contractual obligation to pay debt collector.
9. Furnish a copy of the original promissory note/agreement redacting my social security
number to prevent identify theft and state that your client named above is the holder in
due course of the note agreement and will produce the original for my own and a judge’s
inspection should there be a trial to contest these matters.
10. Produce the account and general ledger statement showing the full accounting of the
alleged obligation that you are now attempting to collect.
11. Identify by name and address all persons, corporations, associations, or any other parties
having an interest in legal proceedings regarding the alleged debt.
12. Verify as a third party debt collector, you have not purchased evidence of the alleged debt
and are proceeding with collection activity in the name of the original maker of the note.
13. Verify you know and understand that certain clauses in a contract of adhesion, such as a
so-called forum selection clause, are unenforceable unless the party to whom the contract
is extended could have rejected the clause without impunity.
14. Verify you know and understand that credit card contracts are a series of continuing
offers to contract and as such are non-transferable.
15. Provide verification from the stated creditor that you are authorized to act for them.
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16. Verify that you know and understand that contacting me again after receipt of this notice
without providing procedurally proper validation of the debt constitutes the use of
interstate communications in a scheme of fraud by advancing a writing, which you know
is false with the intention that others rely on the written communication to their detriment
a violation of United States Code TITLE 18 PART 1 CHAPTER 63 Sec. 1341.
AFFIDAVIT of TRUTH
Sworn under penalties of perjury
Signature(s) of Real Party in Interest:
Printed Name: _____________________________. Signature: __________________________.
EIN/SSN: ______________.
Failure to produce a contract in accordance with the above guidelines may illustrate that the
alleged debt claimed owed was misrepresented and sold to third party debt collectors
fraudulently. I am requesting a full removal of Derogatory reporting in my Credit File from all
three Credit Reporting Agencies. Failure to notify me at the above address of the completion of
these removals within 30 days of receipt of this letter indicates a disregard for the law to exhaust
all efforts to resolve this without litigation.
By: ________________________________ By: _______________________________
(Print Name of Authorized Representative) (Sign Name of Authorized Representative)
NOTARY ACKNOWLEGEMENT
State of ______________
County of ____________
SUBSCRIBED TO before me by ____________________, known to me or proven to me to be
the real man signing this document on this ____________ day of ___________________, 2020.
NOTARY SEAL:
WITNESS my hand and official seal.
______________________________
Notary Public
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