NON-NEGOTIABLE, NON-ASSIGNABLE

The Name (as seen on letter received) Third Party Mailing

c/o Address (as seen on letter received) (Certified Mail Number)
City, State 95002

Today’s date, Month 30, 2005

Debt Collector Name (Add correct name from corporate search)

Address
City, State 77060

Subject: Breach of Contract and Extension of Time

Reference: 1. Account Number 4246 3019 7328 5414, Debt Collectors Name Number 472965170
2. Your Letter, dated 1-30-05

Sir;

On January 1, 2005, The Name (as seen on letter received), requested verification of the debt you are
trying to collect. Debt Collector Name has failed to provide the verification as requested in the allotted
time allowed. Debt Collector Name has now caused The Name (as seen on letter received) a
commercial injury in the amount set certain of 12,000.00 (Same as on the Verification Request) U.S.
Dollars or their equivalence.

I now extend an additional 20 days, (until Month 30, 2005) to provide the requested verification. You
may send the verification to the above address.

If you fail again, I will again hold Debt Collector Name in Breach of the Contract, which will again
cause The Name (as seen on letter received) an additional Commercial Injury with a penalty of an
amount set certain of 12,000.00 (Same as before) U.S. Dollars. All collection costs to be paid by you
and if necessary a Lien may be entered against you upon your full Commercial Liability.
Terms for Injury Compensation are hereby stated and set certain:
For Commercial Injuries incurred, by the actions of Debt Collector Name the amount set certain is twelve thousand (12,000.00) U.S.
Dollars or their equivalent. If this amount is not paid during the time allowed by the invoice, a penalty of two thousand (2,000.00) U.S.
Dollars or their equivalent will be added. In addition, both the amount set certain for the injury and the penalty amount, will bear and begin
to accrue interest at ten (10) percent per annum, also an initial minimum collection fee of one thousand (1,000.00) U.S. Dollars or their
equivalent plus any additional collection cost will accrue to your debt and paid by Debt Collector Name. A Lien may be placed against
you in the Commercial Register among other lawful remedies, which are collectable and will be paid out of Bank account funds.

Notice to Agent is Notice to Principal; Notice to Principal is Notice to Agent.

Presented,

by ___________________________________
Your Name, agent

This is a non-negotiable Legal Instrument under the Uniform Commercial Code (UCC)