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SSN :
DOB :

This is a request to correct inaccurate information being reported in my credit report published by your
company. Upon being denied credit due to information being published in my credit report, I found a
number of items on the report that you are publishing, which are inaccurate. The accounts in question
are listed on page 2.

I have no record of the above accounts and I am demanding that you disclose and verify the original
instrument of indebtedness in its original form which you are relying on, for the reporting on such
collectively referred to as accounts. In accordance with your obligations under the Fair Credit
Reporting Act 15 U.S.C. 1681g the consumer is entitled to said records the requested records. The
information you are reporting is harming my reputation, it's adversely affecting my credit worthiness,
and I am being denied credit as a result of this inaccurate reporting.

I am therefore requesting and demanding that you remove these accounts from my file within 30 days
in accordance with your obligations under the Fair Credit Reporting Act 15 U.S.C. 1681i, or disclose
and verify the original instrument of indebtedness in its original form that you have in your files as of
this date that you rely upon for verification of these accounts.

Black's Law Dictionary, 6th Edition, 1990, defines Verification as, Confirmation of correctness,
truth or authenticity, by affidavit, oath, or deposition. Affidavit of truth of a matter stated and object of
verification is to assure good faith in averments or statements of a party.

Thank You,
I demand the following accounts be disclosed and verified in the original instrument of
indebtedness or be removed immediately.

Name of Unverified Account Number Date Opened Disclose and verify

Account the original
instrument of
indebtedness

Unverified

Unverified

Unverified

Unverified

Unverified

Unverified

Unverified

Unverified

Unverified

Unverified

Unverified

I demand the following inquiries be verified or be removed immediately.

Inquiry Date Verify or remove

Unverified
Unverified
Unverified
Unverified
Unverified
Unverified
Unverified
Unverified
Unverified

Unverified
IN WITNESS WHEREOF, the said party has signed and sealed these presents the day and
year first above written.

Signed, seal, delivered in the presence of:

Signature

STATE OF

COUNTY OF

I HEREBY CERTIFY that on this day before me, and officer duty qualified to take
acknowledgments, personally appeared (name), who is personally know to me or who has
produced as identification and who
executed the far going instrument and he/she acknowledged before me that he/she
executed the same.

WITNESS my hand and official seat in the County and State aforesaid this
day of 2017

Printed Name :

My Commision Expieres: