MOMENT OF TRUTH: JOSEPHINE COUNTY OREGON COURT MUST NOW PROVE CLAIM!!

From: "Jack Lancaster"

Re: MOMENT OF TRUTH: JOSEPHINE COUNTY OREGON COURT MUST NOW PROVE
CLAIM!!

From:"Raymond Karczewski"

MOMENT OF TRUTH: JOSEPHINE COUNTY OREGON COURT MUST NOW PROVE
CLAIM!!
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