NAME

Name
Adress
City, STATE ZIPCODE
PHONE

CREDITOR NAME HERE

123 RIPOFF LANE
ANOTHER TOWN, TX 54321
ATTN: ACCOUNT MANAGER

Certified Mail #: XXXX XXXX XXXX XXXX XXXX

REF: Alleged Account #123456789

RESPA QUALIFIED WRITTEN REQUEST, TILA REQUEST,

DISPUTE OF DEBT AND DEBT VALIDATION LETTER
This letter is a ‘‘qualified written request’’ in compliance with and under the
Real Estate Settlement Procedures Act, 12 U.S.C. Section 2605(e) and
Regulation X at 24 C.F.R. 3500, and The Gramm Leach Bliley Act, A TILA
Request in compliance with the Truth in Lending Act and a Dispute of Debt and
Debt Validation Letter in compliance with the Fair Debt Collection Practices Act
and the Fair Credit Reporting Act

DATE,

Dear Madam or Sir:

I am writing to you to inquire about the accounting and servicing of this mortgage and my
need for understanding and clarification of various sale, transfer, funding source, legal and
beneficial ownership, charges, credits, debits, transactions, reversals, actions, payments, analyses
and records related to the servicing of this account from its origination to the present date.
To date, the documents and information I have, that you have sent, and the conversations
with your service representatives, have been unproductive and have left unanswered questions.
As a consumer, I am extremely concerned about predatory practices, specifically regarding this
mortgage company or anyone who has any interest this matter.
I am concerned about the possibility of potential fraudulent and deceptive practices by
unscrupulous mortgage brokers; sales and transfers of mortgage servicing rights; deceptive and

RESPA QUALIFIED WRITTEN REQUEST, ET AL. Page 1 of 21

fraudulent servicing practices to enhance balance sheets; deceptive, abusive and fraudulent
accounting tricks and practices that may have negatively affected my credit rating, mortgage
account and/or the debt or payments that I am currently, or may be legally obligated to.
THEREFORE, I am legally and lawfully able to demand, and do demand, first hand
evidence and information from you, pertaining to the original, uncertified or certified, security,
regarding my account, #123456789. Failure to provide this security will be confirmation that
you had not created or owned one.
BE AWARE, that notice to the agent is notice to the principal and notice to the
principal is notice to the agent. Any notice or demand made in this correspondence applies to
anyone dealing any part of this account.
Also, I demand that you provide me with information related to the chain of custody of that
same security and its current location. Absent evidence of the security, I will dispute the validity
of your lawful ownership, funding, entitlement right, and the current debt you allege that I owe.
By debt, I am including but am not limited to the principal balance, the calculated monthly
payment, calculated escrow payment and any fees that you claim that I owe or any agent, trust or
entity you may service or subservice for.
To independently validate this debt, I need to conduct a complete exam, audit, review
and accounting of this mortgage account from its inception through the present date.
I request that you conduct your own investigation and audit of this account, since its
inception, to validate the debt that you currently claim I owe. I would like you to validate this
debt, so that it is accurate. Please, do not rely on previous servicers or originators records,
assurances or indemnity agreements and refuse to conduct a full audit and investigation of this
account.
I understand that potential abuses by you or previous servicers could have deceptively,
wrongfully, unlawfully, and/or illegally:
1. Increased the amounts of monthly payments,
2. Increased the principal balance that I owe,
3. Increased escrow payments,
4. Increased the amounts applied and attributed toward interest on this account,
5. Decreased the proper amounts applied and attributed toward the principal on this
account, and/or assessed, charged and/or collected fees, expenses and misc. charges

RESPA QUALIFIED WRITTEN REQUEST, ET AL. Page 2 of 21

 that I am not legally obligated to pay, under this mortgage, note and/or deed of trust.
To insure that I have not been the victim of such predatory servicing or lending practices. I
have authorized a thorough review, examination, accounting and audit of mortgage account
#123456789 by mortgage auditing and predatory servicing or lending experts. This exam and
audit will review this mortgage account file from the date of initial contact, application and the
origination of this account to the present date written above.
Again, this is a Qualified Written Request under the Real Estate Settlement Procedures
Act, codified as Title 12 § 2605 (e)(1)(B)(e) and Reg. X § 3500.21(f)2 of the United States Code
as well as a request under Truth In Lending Act [TILA] 15 U.S.C. § 1601, et seq. RESPA
provides for penalties and fines for non-compliance or failure to answer my questions provided
in this letter within sixty [60] days of its receipt.

ALLEGED DEBT
BE NOTICED THAT This is also a letter of dispute and debt validation. I recently pulled
my credit report and found CREDITOR NAME HERE reporting derogatory information in my
account. I dispute the validity of this debt. I would like to resolve this matter, at the earliest
possible time, however, due to the possibility of error or fraud in this matter, I must insist that
you prove that I owe you this purported debt and state the reasons why I owe this debt.
In order to prove the debt, I must have a signed and sworn statement before a notary
public, under penalty of perjury, by a person having firsthand knowledge of the indebtedness and
stating that the reported indebtedness was a legal indebtedness under all applicable state and
federal laws, was not subsequently disputed as a result of returned, faulty, or recalled consumer
products, and furthermore swearing that this purported debt is not now nor ever has been part of
any tax write off scheme nor insurance claim. Please be advised that I am requesting validation
and competent evidence that I had some contractual obligation sans consumer protection
encumbrance whereby I incurred the original claims associated with this purported debt.
Please be advised, that under the Fair Debt Collection Practices Act, I am authorized to
demand that you not contact me by telephone, nor at my place of employment by any means,
whatsoever. If you wish to communicate with me, you may do so only by U.S. mail and only at
my place of residence.
Your failure to provide such information, as I request in a timely manner, may constitute

RESPA QUALIFIED WRITTEN REQUEST, ET AL. Page 3 of 21

prima facie evidence of intent to defraud, intimidate or coerce me and to deprive me of my civil
rights.
Also be advised, that any contact made by your firm with any 3rd party firm or entity
regarding this issue, absent compliance with each and every part of this demand for validation,
may constitute violation of the FDCPA and the FCRA and may constitute grounds for civil
action, criminal action or complaints being filed against you.

DOCUMENT REQUESTS
In order to conduct a full and complete examination and audit of this loan, I must have full
and immediate disclosure, including copies of all pertinent information, regarding this loan. The
documents requested and answers to my questions are needed to insure that this loan:
I. was originated in lawful compliance with all federal and state laws, regulations
including, but not limited to, Title 62 of the Revised Statutes, RESPA, TILA, Fair
Debt Collection Practices Act, Fair Credit Reporting Act, HOEPA, Regulation Z and
all other applicable laws;
II. That any sale or transfer of this account or monetary instrument, was conducted in
accordance with proper laws and was a lawful sale with complete disclosure to all
parties with an interest;
III. That the claimed holder in due course of the monetary instrument/deed of trust/asset
is holding such note in compliance with statutes, State and Federal laws and is
entitled to the benefits of payments;
IV. That all good faith and reasonable disclosures of transfers, sales, Power of Attorney,
monetary instrument ownerships, entitlements, full disclosure of actual funding
source, terms, costs, commissions, rebates, kickbacks, fees, etc. were and still are
properly disclosed to me;
V. That each of the servicers and/or sub-servicers, of this mortgage, have serviced this
mortgage in accordance with all statutes, laws and the terms of mortgage, monetary
instrument/deed of trust;
VI. That each servicers and sub-servicers of this mortgage have serviced this mortgage in
compliance with local, state and Federal statutes, laws and regulations;
VII.That this mortgage account has properly been credited, debited, adjusted, amortized

RESPA QUALIFIED WRITTEN REQUEST, ET AL. Page 4 of 21

 and charged correctly;
VIII. That interest and principal have been properly calculated and applied to this loan;
IX. That any principal balance has been properly calculated, amortized and accounted for;
X. that no charges, fees or expenses, not obligated by me in any agreement, have been
charged, assessed or collected from this account;
I need copies of pertinent documents to be provided to me. In order to maintain the
integrity of your response, I ask that the all documents be indexed, numbered and labeled
pursuant to this request, specifically, which element of the request that each document(s) or
answer fulfills. I, also, need answers, certified in writing, to various servicing questions. For
each record kept on computer or in any other electronic file or format, please provide a paper
copy of all information in each field or record in each computer system, program or database
used by you that contains any information on this account number or my name.
For clarity, all requests and questions, in this document, pertain to the property located at
129 North Lowell Road, Township of Windham, County of Rockingham, NH [03087] and
account #123456789, from the date of first contact, or loan inception, whichever is first in time,
until the present date.
As such, please send to me, at the address above, copies of the documents, requested
below. Please provide copies of:
1. Any certified or uncertified security, front and back, used for the funding of account
#123456789.
2. Any and all “Pool Agreement(s)”, including account #123456789 between
CREDITOR NAME HERE and any government sponsored entity, hereinafter
referred to as GSE.
3. Any and all “Deposit Agreement(s)” regarding account #123456789 or the “Pool
Agreement”, including account #123456789, between CREDITOR NAME HERE
and any GSE.
4. Any and all “Servicing Agreement(s)” between CREDITOR NAME HERE and any
GSE.
5. Any and all “Custodial Agreement(s)” between CREDITOR NAME HERE and any
GSE.
6. Any and all “Master Purchasing Agreement” between CREDITOR NAME HERE

RESPA QUALIFIED WRITTEN REQUEST, ET AL. Page 5 of 21

 and any GSE.
7. Any and all “Issuer Agreement(s)” between CREDITOR NAME HERE and any
GSE.
8. Any and all “Commitment to Guarantee” agreement(s) between CREDITOR NAME
HERE and any GSE.
9. Any and all “Release of Document agreements” between CREDITOR NAME HERE
and any GSE.
10. Any and all “Master Agreement for servicer’s Principle and Interest Custodial
Account” between CREDITOR NAME HERE and any GSE.
11. Any and all “Servicers Escrow Custodial Account” between CREDITOR NAME
HERE and any GSE.
12. Any and all “Release of Interest” agreements between CREDITOR NAME HERE
and any GSE.
13. Any Trustee agreement(s) between CREDITOR NAME HERE and CREDITOR
NAME HERE’s trustee regarding account #123456789 or pool accounts with any
GSE.
14. Any documentation or evidence of any trust relationship regarding the
Mortgage/Deed of Trust and any Note in this matter.
15. Any and all document(s) establishing a Trustee of record for the Mortgage/Deed of
Trust and any Note.
16. Any and all document(s) establishing the date of any appointment of Trustee
Mortgage/Deed of Trust and any Note. Please also include any and all assignments
or transfers or nominees of any substitute trustee(s).
17. Any and all document(s) establishing any Grantor for this Mortgage/Deed of Trust
and any Note.
18. Any and all document(s) establishing any Grantee for this Mortgage/Deed of Trust
and any Note.
19. Any and all document(s) establishing any Beneficiary for this Mortgage/Deed of
Trust and any Note.
20. Any documentation evidencing the Mortgage or Deed of trust is not a constructive
trust or any other form of trust.

RESPA QUALIFIED WRITTEN REQUEST, ET AL. Page 6 of 21

 21. All data, information, notations, text, figures and information contained in your
mortgage servicing and accounting computer systems including, but not limited to
Alltel or Fidelity CPI system, or any other similar mortgage servicing software used
by you, any servicers, or sub-servicers of this mortgage account from the date of
inception of this account to the date written above.
22. All descriptions and legends of all Codes used in your mortgage servicing and
accounting system so that the examiners, auditors and experts retained to audit and
review this mortgage account may properly conduct their work.
23. All assignments, transfers, allonge, or other document evidencing a transfer, sale or
assignment of this mortgage, deed of trust, monetary instrument or other document
that secures payment by me to this obligation in this account from the date of
inception of this account to the present date, including any such assignments on
MERS.
24. All records, electronic or otherwise, of assignments of this mortgage, monetary
instrument or servicing rights to this mortgage including any such assignments on
MERS.
25. All deeds in lieu, modifications to this mortgage, monetary instrument or deed of
trust;
26. The front and back of each and every canceled check, money order, draft, debit or
credit notice issued to any servicers of this account for payment of any monthly
payment, other payment, escrow charge, fee or expense on this account.
27. All escrow analyses conducted on this account.
28. 2The front and back of each and every canceled check, draft or debit notice issued for
payment of closing costs, fees and expenses listed on any and all disclosure
statement(s) including, but not limited to, appraisal fees, inspection fees, title
searches, title insurance fees, credit life insurance premiums, hazard insurance
premiums, commissions, attorney fees, points, etc.
29. Front and back copies of all payment receipts, checks, money orders, drafts,
automatic debits and written evidence of payments made by others or myself on this
account.
30. All letters, statements and documents sent by your company.

RESPA QUALIFIED WRITTEN REQUEST, ET AL. Page 7 of 21

 31. All letters, statements and documents sent by agents, attorneys or representatives of
your company.
32. All letters, statements and documents sent by previous servicers, sub-servicers or
others in your account file or in your control or possession or in the control or
possession of any affiliate, parent company, agent, sub-servicers, servicers, attorney
or other representative of your company.
33. All letters, statements and documents contained in this account file or imaged by you,
any servicers or sub-servicers of this mortgage.
34. All electronic transfers, assignments, sales of the note/asset, mortgage, deed of trust
or other security instrument.
35. All copies of property inspection reports, appraisals, BPOs and reports done on the
property.
36. All invoices for each charge such as inspection fees, BPOs, appraisal fees, attorney
fees, insurance, taxes, assessments or any expense, which has been charged to this
mortgage account.
37. All checks used to pay invoices for each charged such as inspection fees, BPOs,
appraisal fees, attorney fees, insurance, taxes, assessments or any expense which has
been charged to this mortgage account.
38. All agreements, contracts and understandings with vendors that have been paid for
any charge on this account.
39. All account servicing records, payment payoffs, payoff calculations, ARM audits,
interest rate adjustments, payment records, transaction histories, account histories,
accounting records, ledgers, and documents that relate to the accounting of this
account.
40. All account servicing transaction records, ledgers, registers and similar items
detailing how this account has been serviced.

In order to conduct an audit and review of this account and to determine the proper
amounts due, I need the following answers to issues and questions, concerning the servicing and
accounting of this mortgage from its inception to the present date. Accordingly, please provide
me, in writing, the answers to the requests and questions listed below:

RESPA QUALIFIED WRITTEN REQUEST, ET AL. Page 8 of 21

 ACCOUNTING & SERVICING SYSTEMS
41. Identify each account accounting and servicing system used by you and any sub-
servicers or previous servicers.
42. For each account, accounting and servicing system identified by you and any sub-
servicers or previous servicers, provide the name and address of the company or party
that designed and sold the system.
43. For each account, accounting and servicing system used by you and any sub-servicers
or previous servicers, provide the complete transaction code list for each system.
DEBITS & CREDITS
44. In a spreadsheet form or in letter form in a columnar format, detail each credit on this
account and the date that such credit was posted to this account, as well as the date
any credit was received.
45. In a spreadsheet form or in letter form in a columnar format, detail each debit on this
account and the date the debit was posted to this account, as well as the date any debit
was received.
a. For each debit or credit listed, please provide the definition for each
corresponding transaction code utilized.
i. For each transaction code, please provide the master transaction code list
used by you or previous servicers.
DEBT VALIDATION
46. Sworn validation, by a competent fact witness, that the systems are and have always
been in place to accurately report information to the credit reporting agencies to
prevent the reporting of inaccurate and erroneous information, by you or your agents.
MORTGAGE & ASSIGNMENTS
47. Has each sale, transfer or assignment of this mortgage, monetary instrument, deed of
trust or any other instrument that I executed, to secure this debt, been recorded in the
county property records, in the county and state, in which the property is located,
from the inception of this account to the present date, yes or no?
a. If the answer is no to question #47, then why?
48. Is your company the servicers of this mortgage account or the holder in due course
and beneficial owner of this mortgage, monetary instrument and/or deed of trust?

RESPA QUALIFIED WRITTEN REQUEST, ET AL. Page 9 of 21

 49. Have any sales, transfers or assignments of this mortgage, monetary instrument, deed
of trust or any other instrument that I executed to secure this debt been recorded in
any electronic fashion, such as MERS or other internal or external recording system
from the inception of this account to the present date, yes or no?
a. If the answer is yes to question #49, please detail for me the names of each
seller, purchaser, assignor, assignee or any holder, in due course, to any right or
obligation of any note, mortgage, deed or security instrument that I executed
securing the obligation on this account, that was not recorded in the county
records where my property is located, whether they be mortgage servicing
rights or the beneficial interest in the principal and interest payments.
ATTORNEY FEES
For purposes of my questions below, dealing with attorney fees, please consider the terms
“attorney fees” and “legal fees” to be the same.
50. Have attorney fees ever been assessed to this account?
a. If the answer is yes to question #50, please detail each separate assessment,
charge and collection of attorney fees to this account, from the inception of this
account to the present date and the date of such assessment to this account and
which corresponding payment period(s) and/or month(s) such fees were
assessed.
51. Have attorney fees ever been charged to this account?
b. If the answer is yes to question #51, please detail each separate charge of
attorney fees to this account and the date of such charge to this account and
which corresponding payment period(s) and/or month(s) such fees were
charged.
52. Have attorney fees ever been collected from this account?
a. If the answer is yes to questions #52, please detail each separate incident of the
collection of attorney fees from this account and the date of such collection
from this account and which corresponding payment period(s) and/or month(s)
such fees were collected.
b. Provide the name(s) and address of each attorney or law firm that have been
paid fees or expenses related to this account.

RESPA QUALIFIED WRITTEN REQUEST, ET AL. Page 10 of 21

 53. Identify any provisions, paragraphs, sections or sentences, of any note, mortgage,
deed of trust or any other agreement that I signed which authorized any such
assessment, charge or collection of attorney fees.
54. List and detail any adjustment(s) in attorney fees assessed, charged or collected and
on what date such adjustment(s) were made and the reasons for such adjustment(s).
55. List and detail any adjustments in attorney fees collected and on what date such
adjustment were made and the reasons for such adjustment.
56. Is interest allowed to be assessed or charged on attorney fees, assessed or charged, to
this account, yes or no?
a. Has there been any interest charged on attorney fee(s) assessed or charged to
this account, yes or no?
57. How much, in total attorney fees, have been assessed to this account from the date of
inception of this account until the present date?
58. How much, in total attorney fees, have been collected on this account from the date of
inception of this account until the present date?
59. How much, in total attorney fees, have been charged to this account from the date of
inception of this account until the present date?
60. Please include copies of all invoices and detailed billing statements from any law firm
or attorney that has billed such fees that been assessed or collected from this account.
SUSPENSE/UNAPPLIED ACCOUNTS
For purposes of this section, please treat the terms “suspense account” and “unapplied
account” as the same.
61. Has there been any suspense or unapplied account transactions on this account?
a. If the answer to Question #61 is yes, then explain the reason for each and every
suspense transaction that occurred on this account?
i. In a spreadsheet or in letter form in a columnar format, detail each
suspense or unapplied transaction, both debits and credits, that have
occurred on this account.
LATE FEES
For purposes of my questions below dealing with late fees, please consider the terms “late fees”
and “late charges” to be the same.

RESPA QUALIFIED WRITTEN REQUEST, ET AL. Page 11 of 21

 62. Have you reported the collection of late fees on this account, as interest, in any
statement(s) to me or to the IRS, yes or no?
63. Have any previous servicers or sub-servicers, of this mortgage, reported the collection
of late fees on this account as interest in any statement(s) to me or to the IRS, yes or
no?
64. Do you consider the payment of late fees as liquidated damages to you for not
receiving payment on time, yes or no?
65. Do you consider late fees considered interest, yes or no?
66. Detail expenses and damages which you or others incurred for any and all late
payments.
67. Were any of these expenses or damages charged or assessed to this account in any
other way, yes or no?
a. If the answer to question #67 is yes, then describe what expenses or charges
were charged or assessed to this account?
68. Identify the provisions, paragraphs, sections or sentences of any note, mortgage, deed
of trust or any agreement to authorize to the assessment or collection of late fees?
69. Have any late charges been assessed to this account, yes or no?
a. If the answer to questions #69 was yes, then list and detail each separate late fee
assessed to this account and the corresponding payment period and/or month
that late fee was assessed.
i. How much, in total late charges, have been assessed to this account?
70. Have any late charges been collected to this account, yes or no?
a. If the answer to questions #70 was yes, then list and detail each separate late fee
collected to this account and the corresponding payment period and/or month
that late fee was collected.
i. How much, in total late charges, have been collected on this account?
71. List and detail any adjustments in late fees assessed and the date the adjustment was
made and the reasons.
72. Has interest been charged on any late fee(s) assessed or charged to this account, yes
or no?
73. Is interest allowed to be assessed or charged on late fees charged or assessed to this

RESPA QUALIFIED WRITTEN REQUEST, ET AL. Page 12 of 21

 account, yes or no?
74. Provide the months and/or payment dates you or other previous servicers of this
account claim that there have been late payments.
PROPERTY INSPECTIONS
For purposes of this section, “property inspection” and “inspection fee” refer to any inspection
of property, by any source and any related fee or expense charged, assessed or collected for
such inspection.
75. Explain your policy on property inspections.
76. Do you consider the payment of inspection fees as a cost of collection, yes or no?
a. If the answer to question #76 is yes, then explain why.
77. Do you use property inspections to collect debts, yes or no?
78. Have any property inspections been conducted on the property that is the secured
interest for this mortgage, deed or note, by you, your agents or any previous servicer?
a. If the answer to questions #78 is yes, then list the date of each property
inspection and the corresponding payment period and/or month.
i. List the price charged for each inspection.
ii. List the company name and address and the person who performed each
inspection.
iii. List the reason for each inspection.
iv. List the assessment of each inspection.
v. List the amounts collected for each inspection.
vi. Have you used any portion of the property inspection process to collect or
inform me of a debt, payment or obligation that you allege that I owe?
1. If the answer to question #78(a)(iv) is yes, then list the date(s)
and explain the reason.
79. Identify the provisions, paragraphs, sections or sentences of any note, mortgage, deed
of trust or any agreement that authorized the assessment or collection of property
inspection fees.
80. Have you labeled, in any record or document, a property inspection on this property
as a misc. advance or as anything other than a “property inspection”, yes or no?
a. If the answer to question #80 is yes, then list what it was labeled and explain

RESPA QUALIFIED WRITTEN REQUEST, ET AL. Page 13 of 21

 why.
81. List and detail any adjustments in inspection fees assessed and on what date the
adjustment was made and the reasons for the adjustment.
82. List and detail any adjustments in inspection fees collected and on what date the
adjustment was made and the reasons for the adjustment.
83. Has interest been charged on any inspection fees assessed or charged to this account,
yes or no?
a. If the answer to question #83 is yes, the list when and how much was charged.
84. Is interest allowed to be assessed or charged on inspection fees charged or assessed to
this account, yes or no?
85. How much, in total inspection fees, have been assessed to this account?
86. How much, in total inspection fees, have been collected on this account?
87. Please provide copies of all property inspections made on my property in this
mortgage account file.
88. Have any fee(s) charged or assessed for property inspections been placed into escrow
account, yes or no?
BPO FEES
For this section, the term “BPO” will refer to Broker Price Opinions.
89. Please explain to me your policy on BPOs.
90. Have any BPOs, been conducted on the property that is the secured interest for this
mortgage, deed or note?
a. If the answer to question #90 is yes, then list the date of each BPO conducted
on the property.
b. List the price of each BPO.
c. Who conducted each BPO?
d. List the reason for each BPO.
91. Have any BPO fees been assessed to this account, yes or no?
a. If the answer to question #91 is yes, then how much in total BPO fees have
been assessed to this account?
92. Have any BPO fees been charged to this account, yes or no?
a. If the answer to question #92 is yes, then how much in total BPO fees have

RESPA QUALIFIED WRITTEN REQUEST, ET AL. Page 14 of 21

 been charged to this account?
93. Identify which clauses, paragraphs and/or sentences in the note, mortgage or deed of
trust or any agreement which allows you to assess, charge or collect a BPO fee.
94. Send copies of all BPO reports that have been done on the property.
95. Have any fee(s) charged or assessed for a BPO been placed into escrow, yes or no?
FORCED-PLACED INSURANCE
96. Detail your policies on forced-placed insurance policies.
97. Have you placed or ordered any forced-placed insurance polices on the property?
a. If the answer to question #97 is yes, then list the date of each policy ordered or
placed on the property.
b. List the price of each policy.
c. List the agent for each policy.
d. Explain the reason for each policy.
98. Have any forced-placed insurance fees been assessed to this mortgage or escrow
account, yes or no?
a. If the answer to question #98 is yes, then how much, in total forced-placed
policy fees, have been assessed to this account?
99. Have any forced-placed insurance fees been charged to this mortgage or escrow
account, yes or no?
a. If the answer to question #99 is yes, then how much, in total forced-placed
insurance fees, have been charged to this mortgage or escrow account?
100.Specifically, what clause(s), paragraph(s) and/or sentence(s) in the note, mortgage or
deed of trust or any agreement allow you to assess, charge or collect forced-placed
insurance fees?
101.Do you have any relationship with the agent(s) or agency(s) that placed any policies
on the property?
a. If the answer to question #101 is yes, then describe your relationship with the
agent(s) or agency(s).
i. List the agent(s) or agency(s) with addresses and contact information.
ii. List the date(s) that the policy(s) were placed on the property/
102.Do you have any relationship with any carrier(s) that issued any policies on the

RESPA QUALIFIED WRITTEN REQUEST, ET AL. Page 15 of 21

 property?
a. If the answer to question #102 is yes, then describe your relationship with the
carrier(s).
i. List the carrier(s) with addresses and contact information.
103.If the answer to questions #101 or #102 was yes, then have the agency(s), agent(s) or
carrier(s), that you used to place a forced-placed insurance policy on the property,
provided you any service, computer system, discount on policies, commissions,
rebates or any form of consideration(s)?
a. If the answer to question #103 is yes, then list and describe the service,
computer system, discount on policies, commissions, rebates or any other form
of consideration(s).
104.Do you maintain a blanket insurance policy or any other insurance policy to protect
your properties when customer policies have expired, yes or no?
a. If the answer to question #104 is yes, then list those policies and describe those
policies.
105.Include all copies of forced-placed insurance policies that have been ordered on the
property.
SERVICING RELATED QUESTIONS
106.Did the originator or previous servicers of this account have any financing
agreements or contracts with your company or an affiliate of your company, yes or
no?
a. If the answer to question #106 is yes, then explain those financing agreements
or contracts.
107.Did the originator of this account or previous servicers of this account have a
warehouse account agreement or contract with your company, yes or no?
108.Did the originator of this account or previous servicers of this account receive any
compensation, fee, commission, payment, rebate or other financial consideration from
your company or any affiliate of your company for handling, processing, originating
or administering this loan, yes or no?
a. If the answer to question #108 is yes, then describe and itemize each form of
compensation, fee, commission, payment, rebate or other financial

RESPA QUALIFIED WRITTEN REQUEST, ET AL. Page 16 of 21

 consideration paid to the originator of this account by your company or
affiliate.
109.Identify and explain where the originals of this entire account file are currently
located and how they are being stored, kept and protected?
110. Where is the original signed monetary instrument or mortgage located?
a. Who is holding this note as a custodian or trustee, if applicable?
111. Where is the original signed deed of trust or mortgage and note located?
a. Who is holding this note as a custodian or trustee, if applicable?
112.Has there ever been any assignment of the monetary instrument/asset to any other
party, yes or no?
a. If the answer to question #112 is yes, then identify the names and addresses of
each individual, party, bank, trust or entity that has received the assignment?
113.Has there ever been any assignment of the deed of trust or mortgage and note to any
other party?
a. If the answer to question #113 is yes, then identify the names and addresses of
each individual, party, bank, trust or entity that has received that assignment?
114.Has there been any sale or assignment of servicing rights to this mortgage account to
any other party?
a. If the answer to question #114 is yes, then identify the names and addresses of
each individual, party, bank, trust or entity that has received that assignment or
sale.
115. Have any sub-servicers serviced any portion of this mortgage loan?
a. If the answer to question #115 is yes, then identify the names and addresses of
each individual, party, bank, trust or entity that has sub-serviced this mortgage
loan.
116.Has this mortgage account been made a part of any mortgage pool since the inception
of this loan?
a. If the answer to question #116 is yes, then identify each account mortgage pool
that this mortgage has been a part of.
117.Has each and every assignment of the asset/monetary instrument been recorded in the
county land records where the property associated with this mortgage account is

RESPA QUALIFIED WRITTEN REQUEST, ET AL. Page 17 of 21

 located?
118.Has there been any electronic assignment of this mortgage with MERS [Mortgage
Electronic Registration System] or any other computer mortgage registry service or
computer program?
a. If the answer to question #118 is yes, then identify the name and address of
each individual, entity, party, bank, trust or organization or servicers that have
been assigned the mortgage servicing rights to this account as well as the
beneficial interest to the payments of principal and interest on this loan.
119. Have there been any investors, as defined in your industry, who have participated in
any mortgage-backed security, collateral mortgage obligation or other mortgage
security instrument that this mortgage account has ever been a part of?
a. If the answer to question #119 is yes, then identify the name and address of
each individual, entity, organization and/or trust.
120.Identify the parties and their addresses to all sales contracts, servicing agreements,
assignments, alonges, transfers, indemnification agreements, recourse agreements and
any agreement related to this account.
121. Provide all copies of sales contracts, servicing agreements, assignments, alonges,
transfers, indemnification agreements, recourse agreements and any agreement
related to this account.
122. How much did you pay for this individual mortgage account?
123. If this mortgage was part of a mortgage pool, then what was the principal balance
used, by you, to determine payment for this individual mortgage loan.
a. What was the percentage paid, by you, of the principal balance used to
determine purchase of this individual mortgage loan?
124. Who did you issue a check or payment to for this mortgage loan?
125. Provide front and back copies of the canceled check used to pay for this mortgage
loan.
126.Did any investor approve the foreclosure of my property?
127. Has HUD assigned or transferred foreclosure rights to you as required by 12 USC
3754?
128. Identify all persons or agencies who approved the foreclosure of the property.

RESPA QUALIFIED WRITTEN REQUEST, ET AL. Page 18 of 21

 Please provide me with the documents that I have requested and a detailed answer to each
of my questions and requests within the required lawful time frame. Upon receipt of the
documents and answers, an exam and audit will be conducted that may lead to a further
document request and answers to questions under an additional QWR letter.
Copies of this Qualified Written Request, Dispute of Debt, Validation of Debt, TILA and
request for accounting and legal records letter are being sent to FTC, HUD, Thrift Supervision,
all relevant state and federal regulators; and other consumer advocates; and my congressman. It
is my hope that you answer this request in accordance with law and the questions, documents
and validation of debt accurately and act to correct any abuse(s) or scheme(s) uncovered and
documented.

DEFAULT PROVISION(S) UNDER THIS QUALIFIED WRITTEN

REQUEST
CREDITOR NAME HERE’s or any agents, transfers, or assigns omissions of or acquiescence of
this RESPA REQUEST via certified answer or rebuttal of any and all points, herein this RESPA
REQUEST”, agrees and consents to, including but not limited by, any violations of law and/or
immediate terminate/remove any and all right, title, interests and liens, in John Henry Doe or any
property or collateral connected to John Henry Doe or account #123456789 and waives any and
all immunities or defenses, in claims and or violations, agreed to in this RESPA REQUEST,
including but not limited by any and all of the following:
1. The right, by breach of fiduciary responsibility, fraud and misrepresentation,
revocation and rescinding of any and all power of attorney or appointment
CREDITOR NAME HERE may have or may have had in connection with account
#123456789 and any property and/or real estate connected with account #123456789.
2. The right to have any certified or uncertified security re-registered in John Henry
Doe’s, and only John Henry Doe’s name.
3. The right of collection via CREDITOR NAME HERE’s liability insurance and/or
bond.
4. John Henry Doe’s entitlement in filing and executing any instruments, as power of
attorney for and by CREDITOR NAME HERE, including but not limited by a new
certified security or any security agreement perfected by filing a UCC Financing

RESPA QUALIFIED WRITTEN REQUEST, ET AL. Page 19 of 21

 Statement with the Secretary of State in the State where the CREDITOR NAME
HERE is located.
5. The right to damages because of CREDITOR NAME HERE’s wrongful registration,
breach of intermediary responsibility with regard to John Henry Doe’s asset by
CREDITOR NAME HERE issuing to John Henry Doe a certified check for the
original value of John Henry Doe’s monetary instrument.
6. The right to have account #123456789 completely set off because of CREDITOR
NAME HERE’s wrongful registration, breach of intermediary responsibility with
regard to John Henry Doe’s monetary instrument/asset by CREDITOR NAME HERE
sending confirmation of set off of wrongful liability of John Henry Doe and issuing a
certified check for the difference between the original value of John Henry Doe’s
monetary instrument/asset and what John Henry Doe mistakenly sent to CREDITOR
NAME HERE as payment for such wrongful liability.
CREDITOR NAME HERE or any transfers, agents or assigns offering a rebuttal of this
RESPA REQUEST must do so in the manner of this “RESPA REQUEST” in accordance of and
in compliance with current statutes and/or laws by signing in the capacity of a fully liable man
or woman being responsible and liable under the penalty of perjury while offering direct
testimony with the official capacity as an appointed agent for CREDITOR NAME HERE in
accordance with CREDITOR NAME HERE’s Articles of Incorporation, Article of Incorporation,
by Laws signed by a current and duly sworn director(s) of such corporation/Holding
Corporation/National Association. Any direct rebuttal with certified true and complete
accompanying proof must be posted with the address herein within sixty days. When no verified
response/rebuttal of this “RESPA REQUEST” is made in a timely manner, a “Certificate of
Non-Response” serves as CREDITOR NAME HERE’s acquiescence and consent/agreement by
means of silence with any and all claims and/or violations, herein-stated, in the default
provisions or any other law.

Sincerely,

________________________ ________________________
Name Name,

RESPA QUALIFIED WRITTEN REQUEST, ET AL. Page 20 of 21

ADDRESS
CITY, STATE ZIPCODE
PHONE

CC:
Federal Trade Commission
Office of RESPA and Interstate Land Sales
600 Pennsylvania Avenue NW, Office of Housing, Room 9146
Washington, DC. 20580 Department of Housing and Urban Development
451 Seventh Street, SW

Office of Housing Enterprise Oversight (OFHEO )

1700 G Street, NW., Fourth Floor,
Washington, DC 20552.

RESPA QUALIFIED WRITTEN REQUEST, ET AL. Page 21 of 21