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January 1, 2010

John Consumer
City, State
SSN: 000-00-0000 | DOB: 1/1/1970

P.O. Box 2002
Allen, TX 75013
Attn:Complaint Department

Dear CRA,
My name is xxxxx xxxxxx , my SS # is xxx xx xxxx.
I am sending this dispute certified mail # xxxx to make sure you receive
My report # is xxxxx.
There is no such judgment of record # xxxx from this Court for this date
for this amount from this creditor.
I have certified documentation from the Court that supports my dispute
of this erroneous entry on my report.
If this entry is verified, please send me the name and address of the
provider or furnisher providing this data, and the manner in which it was
provided in order that I may pursue additional legal remedies.

As you know, the Fair Credit Reporting Act requires you to follow
reasonable procedures to assure maximum possible accuracy of
the information on my credit report. Therefore, I am requesting
you verify the items I am disputing at a higher standard than a
computer generated inquiry, e-Oscar or third party database
search. Please also notify the source who reported the item within
5 days after receiving this dispute, and obtain an affidavit sworn
under penalty of perjury of verification directly from a person at
that source.

According to the Fair Credit Reporting Act, Section 609 (a)(1)(A), your company is required by
federal law to verify - through the physical verification of the original signed certified
consumer contract - of any and all accounts you request to be posted and or reported on a
credit report.

I demand to see a copy of the Verifiable, Validated Proof (an original Consumer Contract
with a wet-ink Signature on it, copies of copies are not Validation and by Law are not
considered proof), that you have on file for the account listed above.
Under the FCRA, unverified, invalid accounts must be removed. If you are unable to
provide the me with a copy of the verifiable/validated proof that you have on file within
30 calendar days from receipt of this notice, for the account listed above then you must
at once remove the account from (Your Name) credit reports. I demand the account be
verified or removed immediately!
The law is very clear as to the Civil liability and the remedy available to me for the
"negligent noncompliance" (Section 617) if you fail to comply with this Federal Law.
Your failure to positively verify these accounts has hurt my ability to obtain credit. Under
the FCRA, unverified accounts must be removed and if you are unable to provide me a
copy of verifiable proof, you must remove the accounts listed below.
I demand the following accounts be verified or removed immediately.

Name of Account:
Proof of Verification

1. Chase Bank

Account Number:


Provide Physical

Unverified Account

(Hand Write this information with blue ink pen)

Make sure that you dont have more than 22 accounts listed

When you finish your investigation I want the name, address,

and telephone number of the person at the source you
contacted and an affidavit under declaration of penalty of
perjury from that individual, in other words a fact witness.
The Method of Procedure as mandated by 15 USC section
1681(i)(7)or FCRA section 611 (a) (7).

I will expect you to complete your

investigation within 30 calendar days from the date
you received this dispute or the item being disputed

will be unverifiable and subject to deletion.

Please note that your Credit Reporting Agency is now subject to Federal consumer financial
laws, including, among others, the FCRA and Title X of the Dodd-Frank Act, and related
regulations including a ban on Abusive Acts or Practices. ( Section 1031 of the Dodd-Frank
Act )

Thank You,
Sign your name here
(Your Name Here)

IN WITNESS WHEREOF, the said party has signed and sealed these presents the day and year first above
Signed, sealed and delivered in the presence of:


Witness 1 Print:


Witness 2 Print:
I HEREBY CERTIFY that on this day before me, an officer duly qualified to take acknowledgments,
personally appeared { YOUR NAME HERE }, who is personally known to me or who has produced
_____________________________________________ as identification and who executed the foregoing
instrument and he/she acknowledged before me that he/she executed the same.
WITNESS my hand and official seal in the County and State aforesaid this _____ day of
____________________ 2014.
Notary Public

Printed Name:
My commission expires:


Copy of my Social Security Card & Drivers License is attached
Sent: USPS Certified Mail #
cc. Consumer Financial Protection Bureau (CFPB), PO Box 4503, Iowa City, IA 52244

609. Disclosures to consumers [15 U.S.C. 1681g]

(a) Information on file; sources; report recipients. Every consumer reporting agency shall, upon
request, and subject to 610(a)(1) [ 1681h], clearly and accurately disclose to the consumer:
(1) All information in the consumer's file at the time of the request, except that nothing in this
paragraph shall be construed to require a consumer reporting agency to disclose to a consumer
any information concerning credit scores or any other risk scores or predictors relating to the
(2) The sources of the information; except that the sources of information acquired solely for use in
preparing an investigative consumer report and actually used for no other purpose need not be
disclosed: Provided, That in the event an action is brought under this title, such sources shall be
available to the plaintiff under appropriate discovery procedures in the court in which the action is
(3)(A) Identification of each person (including each end-user identified under section 607(e)(1) [
1681e]) that procured a consumer report
(i) for employment purposes, during the 2-year period preceding the date on which the request is
made; or
(ii) for any other purpose, during the 1-year period preceding the date on which the request is
(B) An identification of a person under subparagraph (A) shall include
(i) the name of the person or, if applicable, the trade name (written in full) under which such
person conducts business; and

(ii) upon request of the consumer, the address and telephone number of the person.
Subparagraph (A) does not apply if-(i) the end user is an agency or department of the United States Government that procures the
report from the person for purposes of determining the eligibility of the consumer to whom the
report relates to receive access or continued access to classified information (as defined in section
604(B)(4)(E)(i)); and
(ii) the head of the agency or department makes a written finding as prescribed under section
(4) The dates, original payees, and amounts of any checks upon which is based any adverse
characterization of the consumer, included in the file at the time of the disclosure.
(5) A record of all inquiries received by the agency during the 1-year period preceding the request
that identified the consumer in connection with a credit or insurance transaction that was not
initiated by the consumer.
(B) Exempt information. The requirements of subsection (a) of this section respecting the
disclosure of sources of information and the recipients of consumer reports do not apply to
information received or consumer reports furnished prior to the effective date of this title except to
the extent that the matter involved is contained in the files of the consumer reporting agency on
that date.
Summary of rights required to be included with disclosure.
(1) Summary of rights. A consumer reporting agency shall provide to a consumer, with each
written disclosure by the agency to the consumer under this section
(A) a written summary of all of the rights that the consumer has under this title; and
(B) in the case of a consumer reporting agency that compiles and maintains files on consumers on
a nationwide basis, a toll-free telephone number established by the agency, at which personnel
are accessible to consumers during normal business hours.
(2) Specific items required to be included. The summary of rights required under paragraph (1)
shall include
(A) a brief description of this title and all rights of consumers under this title;
(B) an explanation of how the consumer may exercise the rights of the consumer under this title;

a list of all Federal agencies responsible for enforcing any provision of this title and the address
and any appropriate phone number of each such agency, in a form that will assist the consumer in
selecting the appropriate agency;
(D) a statement that the consumer may have additional rights under State law and that the
consumer may wish to contact a State or local consumer protection agency or a State attorney
general to learn of those rights; and
(E) a statement that a consumer reporting agency is not required to remove accurate derogatory
information from a consumer's file, unless the information is outdated under section 605 [ 1681c]
or cannot be verified.
(3) Form of summary of rights. For purposes of this subsection and any disclosure by a consumer
reporting agency required under this title with respect to consumers' rights, the Federal Trade
Commission (after consultation with each Federal agency referred to in section 621(B) [ 1681s])
shall prescribe the form and content of any such disclosure of the rights of consumers required
under this title. A consumer reporting agency shall be in compliance with this subsection if it
provides disclosures under paragraph (1) that are substantially similar to the Federal Trade
Commission prescription under this paragraph.
(4) Effectiveness. No disclosures shall be required under this subsection until the date on which
the Federal Trade Commission prescribes the form and content of such disclosures under
paragraph (3).