Written by attorney Robert Walter Dapelo

Information Release Authorization Letter for Bankruptcy

To:[creditor--bank] This will authorize you to deliver to [______] Legal Services a full statement with respect to the following facts concerning: [debtor] [address] Account No. [number] who is a debtor/depositor of yours. Depositor: Total amount of deposit and accrued interest. Debtor: 1. Total amount borrowed; 2. Installment amount; 3. Reason owed; 4. Security interest (if recorded state where and when); 5. Amounts and number of installments in arrears; 6. Present balance; 7. Interest or other costs; 8. Any assignment of debt and to whom; 9. Legal action pending and attorney involved; 10. Photostatic copies of all papers relevant to the transaction or transactions; 11. Date debt incurred; and 12. Codebtors or cosigners. Thank you for your cooperation in this request. [signature] Debtor

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