Registered Mail Number

Date :
(Name)
(Notary intermediary)

To: THE COURT AND DISTRICT ATTORNEY

(Address)

Verified Plain Statement Of Facts

NOTICE TO AGENT IS NOTICE TO PRINCIPLE NOTICE TO PRINCIPLE IS NOTICE TO AGENT

Greetings:

I have received an information from the 16th Judicial District Court STATE OF LOUISIANA VS.
(NAME) case number, however your of a check or replevin bond to balance this liability was not found enclosed
which is a commercial dishonor.

With your actual and constructive possession of the particulars of this information the following is
requested:

1. Full audit trail of this information, all eligible issues of bonds, vouchers, the case cusips number, all
subsequent information relating to the defendant including the True Bill Indictment.
2. To better understand your position and credentials handling this account your Bar I .D. and institutions
taxpayer ID is requested.

As the above information was not included with your offer it is deemed withheld I also am in need of information of
your business plan to process the report of the tax of this event to the IRS as this appears a taxable event and income
to you. If there is a superior claim or assessment or if there is a dispute of title please send your accompanying
lawfully documented evidence and assessments verified containing a wet ink signature expressly stated under pains
and penalty of perjury which is proper and warranted to verify your responsibility to handling this information.

Your prompt attention is requested and that this is my civil acceptance and authorization of the use of my personal
information which you possess and all account numbers to close and settle this account in discharge of your public
duty. Please adjust this account for the proceeds, products, accounts and fixtures and all good and valuable
considerations and release the order immediately as this account is prepaid and this property is Exempt from Levy.

This matter is accepted for voluble consideration and my Civil Acceptance. Please responds only to the
above intermediary acceptor for proper witness in 72 hours which is three (3) days Truth in Lending. After 15
days there will be fault and after 21 days there will be default and construed your full agreement of the all terms and
conditions of the default.

Non- response or failure to return a certified response within the specified period only to the above
intermediary for proper witness, failure produce any such superior claim will be construed that no superior claim or
verified assessments exist and that you maybe voluntarily holding taxable income and in dishonor. Any unverified
responses, non-response or any response not through the intermediary location above will be considered a defective
response and maybe recorded in a private “Default” judgment. A Default will indicate that there is no effort on part
of the officer of this matter to disclose all material facts, discharge this matter under public policy for settlement and
closure nor reveal anything in full disclosure.

Default would be dishonor and construed bad faith stipulating your agreement that all powers of attorney or
authority to be vested in the defendant in witness of the U.S. trustee in the bankruptcy to help close and settle this
matter case/account Complaint number and this “default” and certifying dishonor to send to the United States
Treasury for adjustment, balancing, settlement and closure of this account.

CERTIFICATION

I (NAME) competent to witness certify under my own Commercial liability with first hand

knowledge of the facts stated above that the statements are fact, true, correct, complete and certain, the truth the

whole truth and nothing but the truth to the best of my knowledge. Look forward to hearing from you.

Until then,

By:________________________________
(NAME)
Encl. Offer: Affidavit of Acceptance all rights reserved
Blank W-9 Form exempt from levy
IRS 4490
 NOTARY PROOF OF MAILING AND CERTIFICATE OF SEVICE

I the undersigned notary public for the Parish of Louisiana and State of LOUISIANA Sworn and subscribed before me under pains and

penalty of perjury in accord with all laws of the State of the LOUISIANA and witnessed a man appeared

before me known as (NAME) and attesting to his above certification and autograph. I the undersigned notary caused to be

mailed on his behalf this package containing:

1. IRS W-9
2. Insturments
4. IRS 4490

Sent on his behalf by Registered Mail Number to the concerned District attorneys office THE COURT AND DISTRICT

ATTORNEY OF 16TH JUDICIAL DISTRICT COURT

for want of response to notary acceptor above.

NOTARY PUBLIC _________________________________

My commission expires ______________________