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_________________________________________
AUTHORIZATION
ψ:
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0 0 0 1 1 1 1 1 130001
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Statement of Account
[These instructions must remain
attached to the instrument.]
These instructions
are based on Regulation J at 12 CFR and portions of 15 USC.
Exchange #: 130001
Certified #: 7002 2030 0007 7521 0000
Registered #: RR 449 331 000
US
Creditor
I have accepted the attached offer for value
and am returning it for value with a bill of exchange to settle
account # 9798 valued at 3800.00. It could take up to 20 days for
this instrument to be processed and your account credited. If the
credits are not available after 20 days, please contact me for a
Notice of Error to send to your bank.
I am enclosing a copy of the Notice of
Preauthorized Transfer I mailed to John Snow with copies of my bill
of exchange and your charging instrument. He is the trustee on the
bankruptcy of the United States, and is the only one who has
authority to dishonor my bill of exchange.
Prepare a deposit slip and endorse the bill of
exchange on the back as you would a check. Make a copy of the
entire package for your records, and mail all the original documents
with the deposit slip to your bank. If your bank informs you that
the trustee has dishonored my bill of exchange, please notify me
immediately.
Financial
Institution
Deposit the credits in your customer’s account with a hold during
the verification period if necessary. The department that handles
the TT&L account for the bank must process this bill of exchange
information to John Snow electronically. It is a prepaid exchange
item that must be processed through FedWire directly to John Snow,
who is the trustee on the bankruptcy of the US and the one who
handles the accounting on my exemption. You will not receive funds,
credits, or money from the US Treasury. The credit is in the
attached instrument. My private asset account is the pass through
to the trustee’s approval of the use of my exemption. This is an
accrual entry.
Pertinent
Information:
exchange value: 38000.00
direct treasury account #: R 792 407 000 – 123456789
pass through private setoff account #:
y: 1 2 3 4 5
6 7 8 9 y:
0 0 0 1 1 1 1 1
exemption identification and bond #: 123456789
creditor: ABC COMPANY, INC
debtor: JOHN HENRY DOE
No other approval is required to honor my bill
of exchange. When you do not receive a notice of dishonor from the
trustee within 15 days, release the hold on the credits making them
available to your customer. If you do receive a notice of dishonor
from the trustee, please notify your customer immediately.
You may direct
bill me at the address shown below for any processing fee that might
be involved.
Thank You,
____________________________________
John Henry Doe
c/o 123 West Street
Anywhere, ST 67000
Pre-Paid Exchange – Preferred Stock
Priority – Exempt from Levy
Option #2
JOHN HENRY DOE
PO Box 11111
Tucson, AZ 85000
ABC MORTGAGE
CO., INC.
Certified #
8676 5438 6837 6292 8277
1100 Westward Circle, Suite 101
Winkle, California 90000
Re: Account # 333333333333333333 [or loan
number]
Deed recorded at # 6060606, Book 656, Page 87 in Maricopa
County, Arizona
PREAUTHORIZED TRANSFER
Certified # 8676 5438 6837 6292 8277
Registration # RR 111 111 111 US
To Whom It May Concern:
I, John Henry Doe, do hereby authorize ABC
MORTGAGE CO., INC. and/or an agent thereof, to use my exemption
# 123456789 through FedWire to settle the account
identified above.
Credit to the Order of: ABC
MORTGAGE CO., INC.
Amount: $98,349.00
Ninety-eight thousand three hundred forty-nine and no/100
For Further
Credit to: Account # ______________________
[to be supplied by ABC Mortgage Co.]
Debtor:
JOHN HENRY DOE 123-45-6789
Set-off Account No.: 123456789
12121212121
Registered with John Snow, Trustee # RR 444 444 444 US
Endorsement
___________________________________________ Date:
_________________
Authorized signature of Creditor
_______________________________
John Henry Doe
EIN 123456789
Arizona
)
) ss
ACKNOWLEDGEMENT
Maricopa
county )
I, ________________________________,
a Notary Public for said County and State, do hereby certify that
John Henry Doe , personally appeared before me and
signed the foregoing. Witness my hand and seal this _______ day of
____________________, 2003.
_____________________________________
____________________________________
Notary
Public
My Commission expires
Void Where Prohibited by Law
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