
Today's Date: __________________________ 
Collector's Name: ____________________________________ 
 
Collector's Address : ____________________________________________ 
 
        ____________________________________________ 
RE:    Account of ______________________________________(your name) 
Account # _______________________________ 
Dear Collector,  
I am writing in response to your letter or phone call dated __________________. 
I do not believe that I owe this debt or what you say I owe.  
Pursuant to the Fair Debt Collection Practices Act, Section 809(b), Validating 
Debts:  
“If the consumer notifies the debt collector in writing within the 
thirty-day period described in subsection (a) that the debt, or any 
portion thereof, is disputed, or that the consumer requests the 
name and address of the original creditor, the debt collector shall 
cease collection of the debt, or any disputed portion thereof, until 
the debt collector obtains verification of the debt or any copy of a 
judgment, or the name and address of the original creditor, and a 
copy of such verification or judgment, or name and address of the 
original creditor, is mailed to the consumer by the debt collector.” 
(emphasis added) 
I respectfully request that you provide me with the following:  
1.  the amount of the debt;  
2.  the name of the creditor to whom the debt is owed; 
3.  verification or copy of any judgment (if applicable);  
4.  proof that you are licensed to collect debts in Maine; 
5.  proof of the last payment made on the account. 
I am asserting my rights under the federal and state Fair Debt Collection 
Practices Acts and the Fair Credit Reporting Act, including these rights:  
•  Because I have disputed this debt in writing within 30 days of receipt of 
your initial notice, you must obtain verification of the debt or a copy of the 
judgment against me and mail these items to me at your expense.