Affidavit and Notice of Default - Sample-A4v

U.S.P.S.
Certified Mail Number 70112970000026320204
By and from: )
Secured Party: )
Charles Joseph Adams )
c/o 5252 Cote Brilliante Avenue )
Saint Louis, MO [63113-9999] )
)
Affiant ) NOTICE OF DEFAULT
)
SANTANDER CONSUMER USA, INC. )
PO BOX 961245 )
FORT WORTH, TX 76161-1245 )
(888) 222-4227 )
)
Respondent )
Account No. 30000197454191000
NOTICE TO AGENT IS NOTICE TO PRINCIPAL

NOTICE TO PRINCIPAL IS NOTICE TO AGENT
AFFIDAVIT OF NOTICE OF DEFAULT
December 17, 2012
Introductory Certification
I, Charles Joseph Adams, the Undersigned Secured Party, hereinafter "Affiant,"

does herewith solemnly swear, declare, and state that by affidavit that of non-response of the
respondent to the contract titled, CONDITIONAL ACCEPTANCE FOR ACCEPTANCE
FOR VALUE FOR PROOF OF CLAIM (CAFV), hereinafter, are in full agreement
regarding the following.
Plain Statement of Facts
1. THAT Affiant is competent to state the matters included in his declaration, has knowledge
of the facts, and declared that it is the best of his knowledge, the statements made in his
affidavit are true, correct, and not meant to mislead;
2. THAT Affiant is the secure party, superior claimant, holder in due course, and principal
creditor, having a registered priority lien holder interest to all property held in name of the
Debtor; CHARLES JOSEPH ADAMS.
3. THAT SANTANDER CONSUMER USA, INC., hereinafter, "Respondent", is in dishonor

and thus defaulted on said Conditional Acceptance For Acceptance For Value For Proof Of
Claim by failing to establish Liability of Affiant through any of the enumerated proofs of
claims within 10 days of its service via his agent;
1
4. THAT SANTANDER CONSUMER USA, INC., is in dishonor/default regarding refusal
to respond to Conditional Acceptance For Acceptance For Value For Proof Of Claim,
received on November 30th, 2012, by Certified mail number 70112970000026320198,
signed by Gini Moore, agent/receptionist, SANTANDER CONSUMER, USA, INC. has
given permission for a lien to be filed against them in the amount of Five Hundred Thousand
United States Dollars ($500,000.00) for said admission, confession, dishonor by silence, and
default;
5. THAT your correspondence of 12/03/2012 was received by me on December 14, 2012. I

Conditionally Accept for Value (CAFV) your contract in that letter of a $15,354.00 balance
remaining on the above-referenced loan, and Return the same For Value.
Attached you will find my (CAFV) accompanied by a Money Order for $15,500.00 made
payable to the United Stated Treasury, to credit, settle, and close account number,
30000197454191000 with SANTANDER CONSUMER USA, INC.
Please understand that I want to resolve this matter as soon as possible and see the need to
exhaust my administrative remedy/process, I now request the above proofs of claim' that
you rely upon to support your claim in this matter.
Verification of Certification
The Undersigned Affiant, Charles Joseph Adams, does herewith swear, declare, and
affirm that Affiant executes this Affidavit with sincere intent, that Affiant can competently
state the matters set forth herein, that the contents are true, correct, complete, and certain, not
misleading, and the truth, the whole truth, and nothing but the truth in accordance with
Affiant's best firsthand knowledge and understanding.
Date: The Seventeenth Day of the Twelfth Month in the Year of Our Lord Two Thousand
and Twelve.
Sincerely
Without Prejudice Date: December 17, 2012
Authorized Representative, Attorney-In-Fact
Charles-Joseph: Adams Secured Party Creditor
For CHARLES JOSEPH ADAMS ENS LEGIS
Signed: ____________________________________________________________
Autograph Common Law Copyright 2012 by Charles Joseph Adams. All Rights
Reserved. No part of this Common Law Copyright may be reproduced in any manner
without prior, express, written permission from Charles Joseph Adams as signified by
Charles Joseph Adams's signature in blue ink. Unauthorized use of " Charles Joseph
Adams" incurs same unauthorized-use fees as those associated with " CHARLES
JOSEPH ADAMS"
Please direct responses to third party public witness:

Audrey Marie Adams
c/o 1015 Chartres Avenue
Saint Louis, Missouri [63132-9999]
2
Attached: CONDITIONAL ACCEPTANCE FOR ACCEPTANCE FOR VALUE FOR
PROOF OF CLAIM (CAFV), - Nov. 30, 2012 (copy)
Attached: CONDITIONAL ACCEPTANCE FOR VALUE
CC: UNITED STATES TREASURY;

IRS CRIMINAL INVESTIGATION DIVISION
State of Illinois )
) ss: Jurat
County of St. Clair )
Subscribed and sworn to (or affirmed) before me on this 17th day of December, 2012 by
Charles-Joseph: Adams, proved to me on the basis of satisfactory evidence to be the person
who appeared.
_________________________________ _____________________________
Signature: Date:
SEAL

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U.S.P.S.

Certified Mail Number 70112970000026320204

Account No. 30000197454191000

NOTICE TO AGENT IS NOTICE TO PRINCIPAL

AFFIDAVIT OF NOTICE OF DEFAULT

December 17, 2012

I, Charles Joseph Adams, the Undersigned Secured Party, hereinafter "Affiant,"

3. THAT SANTANDER CONSUMER USA, INC., hereinafter, "Respondent", is in dishonor

5. THAT your correspondence of 12/03/2012 was received by me on December 14, 2012. I

Please direct responses to third party public witness:

CC: UNITED STATES TREASURY;

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