CERTIFICATE OF NON-RESPONSE

STATE OF CALIFORNIA )
) ss
COUNTY OF ORANGE )

PRESENTMENT Be it known, that, the person signing below, a duly empowered Notary Public, at the request
John Henry Doe 1234 Main Street, Huntington Beach, California 92648
of_____________________________ In care of __________________________________________________:
Claimant Address
NOTICE TO SETOFF ACCOUNTS; PRIVATE REGISTERED SETOFF BOND; and
April 6, 2010
did duly present on ________________ the attachedMORTGAGE STATEMENT OF ACCOUNT
____________________________________________________________________
January 26, 2010
dated _______________,
I.R.S. Technical Support Division, c/o Treasury UCC Contract Trust, Internal Revenue Service, 1500 Pennsylvania Avenue, N.W., Washington, D.C. 20220
to ____________________________________________________________________________________________________________

_______________________________________________________________________________________________________________

_______________________________________________________________________________________________________________

_______________________________________________________________________________________________________________
Respondent(s)

John Henry Doe

signed by ___________________________ requestingAcceptance, notice of defect, or notice of dishonor
_________________________________________________________________,
the time limit having elapsed for a timely response thereto.

DEFAULT Whereupon, the Notary Public signing below, for the reason dishonor by non-response, does publicly and solemnly certify
the dishonor as against all parties it may concern by reason of non-response thereof and stipulations therein.

TESTIMONY In testimony of the above, I have signed my name and attached my official seal

___________________________________________
Notary Public
August 24, 2010
My commission expires: __________________
April 17, 2010
Date __________________