John Henry Doe
c/o  123 Main Street
Anytown, [12345]
Texas

USER NAME HERE								     123 MAIN ST				
Anyton, TX 54321								
Date: November 13, 2003

USER NAME HERE, Disclosure Officer:

This is an individual Privacy Act request under 5 U.S.C. § 552a and appropriate regulations. 
This is my firm promise to pay fees and costs for locating, duplicating and reviewing the documents for information requested below. 
I am making this individual requests in the classification of “other requester.” if costs are expected to exceed $50.00 please send estimated costs. 
If some of this request is exempt from release, please send those portions reasonably segregable and provide me with indexing, itemization, and detailed justification concerning the information you are not releasing. 
The information will provide knowledge and understanding of the rules and regulations of the agency, and will assist the requester relative to the policies of the agency. 
I understand the penalties provided in 5 U.S.C. § 552(a)(1)(3) for requesting or obtaining access to documents or records under false pretenses. 
I am the person making this request and my signature appears below. 
Please expedite this Privacy Act request.

At this point in time: Regarding Account # 123456789 at CREDITOR NAME HERE:

1	I request copies of ALL existing records or documents or BOTH that show within any file(s) of CREDITOR NAME HERE, ALL proof of shares or capital CREDITOR NAME HERE used, of its own, to make loan # 123456789. 

2.	I request copies of any document that establishes whether CREDITOR NAME HERE is effective as the broker regarding account or transaction # 123456789. 

3.	I request any documents that establish that CREDITOR NAME HERE as the creditor regarding account or transaction # 123456789.

4.	I request any certified or registered name(s) and approved filing number(s) used for the funding or crediting source to account or transaction # 123456789 at CREDITOR NAME HERE.

5.	I request any copy(ies) of a certified copy, front and back side(s), of any such note or document(s) used to fund account or transaction # 123456789 at CREDITOR NAME HERE.

6.	I am requesting copies of all records and documents within the registry of the United States Securities Exchange Commission that show the certified or registered investment security that CREDITOR NAME HERE, a national bank, has an interest in account or transaction # 123456789. 

7.	I request all documents that show that CREDITOR NAME HERE is the issuer or holder in due course in account or transaction # 123456789.

8.	I request certified confirmation that CREDITOR NAME HERE is effecting account or transaction # 123456789 as the dealer.

9.	I request certified confirmation of account or transaction # 123456789 being a security obligation of CREDITOR NAME HERE.

10.	I request certified confirmation CREDITOR NAME HERE is effecting account or transaction # 123456789 in a fiduciary capacity.

11.	I request copies of any document that establishes whether CREDITOR NAME HERE is effective as the trustee regarding account or transaction # 123456789. 

12.	I request certified documentation that CREDITOR NAME HERE facilitated the transfer of funds or securities as the clearing agency re account or transaction # 123456789.

13.	I request certified documentation that CREDITOR NAME HERE facilitated the transfer of funds or securities as the custodian re account or transaction # 123456789.

14.	I request a certified copy of CREDITOR NAME HERE’s Fidelity bond and any errors and omissions policy as required by law.

15.	I request a true complete copy of CREDITOR NAME HERE’s registered and filed Articles of Association.

16.	I request a true complete copy of CREDITOR NAME HERE’s registered and filed Articles of Incorporation.

17. 	I request any documentation evidencing CREDITOR NAME HERE as a ''insured bank'' member.

18. 	Regarding account # 123456789 I request all specific names of any: 
a.	Issuer
b.	Confirmer 
c.	Drawer 
d.	Drawee 
e.	Beneficiary
f.	Customer
g.	Presenter
h.	Nominated person
i.	Successor of a beneficiary
j.	Beneficial owner

19.	I request a certified copy of the designation given to CREDITOR NAME HERE by the U.S. Secretary of Housing and Urban Development (HUD) to serve as a foreclosure commissioner for the purpose of foreclosing, pursuant to 12 USC 3754: (This one to Sec of HUD Disclosure office Remove this section when complete)

20.	I request any documentation evidencing CREDITOR NAME HERE as the “servicer” regarding account # 123456789 (to the Banks and Banks Regulator)

21.	Please send to the requester the servicing agreement for account # 123456789.

22.	Because (Fannie Mae, Freddie Mac, Ginnie Mae) has a claim of ownership and Holder in Due Course status made on [date here], see attached, please send to the requestor CREDITOR NAME HERE’s document(s) establishing CREDITOR NAME HERE’s superior claim over (Fannie Mae, Freddie Mac, Ginnie Mae) regarding account # 123456789. (to Bank and Bank Regulator)

If no documentation or information or both exist in ANY files or records you have, regarding this Privacy Act request herein, please send a record stating NO SUCH CERTIFIED DOCUMENTATION OR INFORMATION EXISTS within any files or records.

If the USER NAME HERE does not maintain any of the Information or Requests please forward a copy of any portions of this Privacy Act requests to the appropriate department that does and notify the requestor of the appropriate department and that the USER NAME HERE has forwarded it accordingly.

Thank you for your time and attention to this matter.

__________________________
								John Henry Doe

Attachments: Requestor identification