Debt Validation Notice (Collector to Consumer)

VALIDATION NOTICE

(Required Disclosure Under 15 U.S.C. Section 1692g and 12 CFR Section 1006.34)

Date of This Notice: [DATE]

DEBT COLLECTOR INFORMATION

[DEBT COLLECTOR NAME]
[ADDRESS LINE 1]
[ADDRESS LINE 2]
[CITY, STATE ZIP]
[PHONE NUMBER]

CONSUMER INFORMATION

[CONSUMER FULL LEGAL NAME]
[ADDRESS LINE 1]
[ADDRESS LINE 2]
[CITY, STATE ZIP]

ACCOUNT INFORMATION

Account Number: [FULL OR PARTIAL ACCOUNT NUMBER]

Creditor to Whom the Debt Is Owed:
[CURRENT CREDITOR NAME]
[CURRENT CREDITOR ADDRESS]

Original Creditor (if different):
[ORIGINAL CREDITOR NAME]

MINI-MIRANDA DISCLOSURE

[DEBT COLLECTOR NAME] is a debt collector. We are trying to collect a debt that you owe to [CURRENT CREDITOR NAME]. We will use any information you give us to help collect the debt.

AMOUNT OF THE DEBT

As of [ITEMIZATION DATE]:

Itemization Date Selected:

☐ Last Statement Date: [DATE]
☐ Charge-Off Date: [DATE]
☐ Last Payment Date: [DATE]
☐ Transaction Date: [DATE]
☐ Judgment Date: [DATE]

INFORMATION ABOUT YOUR RIGHTS

How to Get More Information

You have the right to ask us questions about the debt.

Dispute the Debt

If you think you do not owe the debt, or you think the amount is wrong, you can dispute the debt.

You must send us a letter at the address above by [DATE - 30 days from mailing] telling us you dispute the debt.

If you send a letter by that date, we must stop all collection activity on the debt until we send you written verification of the debt.

Ask for the Original Creditor's Information

If you want us to tell you the name and address of the original creditor, you must send us a letter at the address above by [DATE - 30 days from mailing].

Your Rights Under Federal Law

Dispute all or part of the debt: Write to tell us if you think you do not owe the debt or do not owe the amount. You may dispute all or part of the debt. If you dispute the debt within 30 days of receiving this notice, we must stop collection activity on the debt until we send you written verification.

Get the name and address of the original creditor: Write to request the original creditor's information if the current creditor is different.

HOW TO RESPOND

To Dispute This Debt:

You may use the response form below, or write to us at:

[DEBT COLLECTOR NAME]
[DISPUTE ADDRESS]
[CITY, STATE ZIP]

To Make a Payment:

Online: [SECURE PAYMENT URL]
By Phone: [PAYMENT PHONE NUMBER]
By Mail: Make check payable to [PAYEE] and send to [PAYMENT ADDRESS]

Include your account number: [ACCOUNT NUMBER]

IMPORTANT DEADLINES

Response Deadline for Disputes and Information Requests: [DATE - 30 days from mailing/delivery]

If you do not dispute the debt in writing within 30 days after you receive this notice, we will assume the debt is valid.

If you dispute the debt or request original creditor information after the 30-day period, we are not required by law to stop collection or provide verification, but may do so voluntarily.

TIME-BARRED DEBT NOTICE

☐ If the debt is NOT time-barred, include this statement:
We can legally sue you to collect this debt.

☐ If the debt IS time-barred, include this statement:
The law limits how long you can be sued on a debt. Because of the age of your debt, we will not sue you for it. If you do not pay the debt, [DEBT COLLECTOR NAME] may continue to report it to the credit bureaus as unpaid for as long as the law permits.

STATE-SPECIFIC DISCLOSURES

☐ California Residents: As required by the Rosenthal Fair Debt Collection Practices Act (Cal. Civ. Code Section 1788 et seq.), this notice is sent to inform you of your rights.

☐ New York City Residents: [INSERT REQUIRED NYC DCA DISCLOSURES]

☐ Massachusetts Residents: [INSERT REQUIRED DISCLOSURES]

☐ Other Applicable State Disclosures: [INSERT]

RESPONSE FORM

(Complete and return by [DEADLINE DATE])

Account Number: [ACCOUNT NUMBER]
Consumer Name: [CONSUMER NAME]

Check all that apply:

☐ I do not owe this debt. The reason I do not owe this debt is:
_________________________________________________________________
_________________________________________________________________

☐ The amount is wrong. The amount I believe I owe is: $__________
The reason the amount is wrong is:
_________________________________________________________________

☐ I want you to send me the name and address of the original creditor.

☐ Enclosed is my payment of: $__________

☐ I want to discuss payment options. The best way to reach me is:
Phone: _________________________ Best time: _____________
Email: _________________________

Signature: _________________________________ Date: _______________

Print Name: _________________________________

LEGAL COMPLIANCE STATEMENT

This Validation Notice is provided in compliance with:

• Fair Debt Collection Practices Act, 15 U.S.C. Section 1692g
• CFPB Regulation F, 12 CFR Section 1006.34
• Applicable state debt collection laws