PLC Documentation Retainer Agreement Devillez

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    APPLICATION FOR LOSS MITIGATION SERVICES

    Dear Madam / Sir,

    Enclosed are the loss mitigation forms you requested from Protection Law Center,LLC.

    If needed, please call your legal assistant to assist you in filling out this package

    Phone:

    888.745.7988 ext ( )

    Fax: 866.

    545.2959

    Email:

    Website:

    WWW.THEPLCLAW.COM

    Once your enrollment package is accepted by The Protection Law Center LLC, you will have our legal team at yourfingertips that will work on your behalf. Our legal staff will work diligently with your lender and assist you towardsfinancial stability. Your lender is a professional debt collector and will protect their interests first. Lenders simply

    do not have the time or manpower to assist borrowers in a timely fashion and ina manner that benefits thehomeowner. Our legal team will not let you fall between the cracks, as your bankhas done. We have successfullyworked with lenders across the country in reducing interest rates, fixing adjustable rate mortgages, reallocatingmortgage arrears, postponing foreclosure sale dates and other loss mitigation services. The PLC LLC makes nopromises or guarantees on interest rate or loan terms, but will work diligentlyon your behalf to negotiate andobtain the best possible offer from your lender. Please review our service agreement and scope of representationwhich you will need to sign to accept the services we provide.

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    Once you have submitted the requested documentation, we will process your application immediately anddetermine if we can assist you in any way.

    PLC, LLC makes no promises in regards to interest rates or terms. The loss mitig

    ation process may take anywherefrom 30 days to several months to achieve desired results from your lender. Please refer to our service agreementand our scope of representation which you will need to sign, to review our services. If you receive any paperworkor documents from your lender during this process, please call your negotiator immediately and send us thepaperwork to review and address on your behalf. At no time does the PLC LLC recommend our clients to miss anymortgage payments.

    Applicant:

    Date:

    Co-Applicant:

    Date:

    Please sign to verify you have read the above letter

    Regards,

    Protection Law Center LLC.

    PLC

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    Directions On How To Begin

    For PreApprovalComplete Steps 1 through 5

    1. Print the entire Application

    2. Complete the Borrower Enrollment Form.

    3. Complete the Financial Worksheet to the best of your ability.

    4. Complete the Hardship Letter Worksheet.

    5. Complete and sign the Borrowers Certification & Authorization form

    6. If youre going to pay by electronic check please sign theauthorization form.

    7. Please include the following:

    a. _____ pay stubs for the last thirty days

    b. _____ your last 2 yearsW-2 statements

    c. _____ if self employed year to date profit and loss statement

    d. _____ if self employed last 2 years full tax returns (all pages)

    e. _____ rental leases if applicable

    f. _____ if applicable social security, pension and/or disability statements

    g. _____ your most recent mortgage statement

    h. _____ declaration page of homeowners insurance policy if not included in mortgage

    i. _____ property tax bill if not included in mortgage

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    j. _____ any documentation that you may feel is relevant

    *Please note: We may ask for additional documentation based on your case, and will needupdated documents throughout the process.

    If you have questions we have the solutions!

    Just call our office.

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    BORROWER ENROLLMENT FORM

    Applicant Name

    Social Security

    Co-Applicant Name

    Social Security

    Applicant Date of Birth

    Applicant HomePhone

    Co-Applicant Date of Birth

    Co-Applicant HomePhone

    Applicant Cell Phone

    Email Address

    Co-Applicant Cell Phone

    Email Address

    Applicant Address (Property)

    Co-Applicant Address (Property)

    Street

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    Address:

    StreetAddress:

    Applicant Address (Mailing)

    Co-Applicant Address (Mailing)

    StreetAddress:

    StreetAddress:

    Employer:

    Employer:

    Position:

    Phone:

    Position:

    Phone:

    Employment Date: (from -

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    to)

    -

    Salary

    Employment Date: (from -to)

    -

    Salary

    First Mortgage Information:

    Second Mortgage Information:

    Mortgage Company Name:

    Mortgage Company Name:

    Loan #:

    Loan #:

    Interest Rate:

    %

    Interest Rate:

    %

    Loan Balance:

    Loan Balance:

    Fixed or Adjustable:

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    Fixed or Adjustable:

    Months Behind:

    Months Behind:

    Loan Companys Phone #:

    Loan Companys Phone #:

    Are you currently in foreclosure?

    If yes, do you have a saledate?

    If yes, when is it?

    Have you received a Modification/Forbearance plan within the last 12 months?

    If yes, when?

    Are you currently in bankruptcy?

    Have you ever filedbankruptcy?

    If yes, chapter 7 or chapter13?

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    Hardship Letter Worksheet

    A Hardship letter is something all Mortgage Companies will require to consider you for one of their loss

    mitigation services. This is your opportunity to appeal to them to give you another chance. This shouldnot be used to complain to what they have done or not done to make your situation worse. This mustbe honest and represent the facts clearly. It must prove the situation that caused you to fall behind.You must also have a legitimate excuse for falling behindtoo much in debt in itself would not be anadequate reason. Continue on a separate sheet of paper, if needed.

    I/We are having problems making my monthly payments because of financial difficulties created by:

    (check all that apply)

    Unemployment Reduced Income Divorce/Separation

    Death of My Spouse Payment Increase Military Service

    Business Failure Job Relocation Illness

    Incarceration Death of Family Member Medical Bills

    Damage to Property Adj. Rate Mortgage

    Other

    Explain EACH Financial difficulty that you check above (please be specific):

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    This difficulty or situation happened on or about

    How many children/grandchildren do

    Ages:

    Other

    Total Occupants living in

    What are you doing to make your situation better?

    By Signing below, I certify the above information contained herein to be true &correct.

    ApplicantSignature:

    Date:

    Co-ApplicantSignature:

    Date:

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    BORROWERS CERTIFICATION AND AUTHORIZATION CERTIFICATION

    The Undersigned certify the following:

    1. I/We have applied for a Loss Mitigation Services from PLC LLC in applying forthe Services, I/Wecompleted an application containing various information on the purpose of the Loss MitigationServices, the amount and source of the rate and payment adjustments, employmentand incomeinformation and the assets and liabilities. I/We certify that all of the information is true andcomplete. I/We made representations for the Loss Mitigation Services or other documents, nor did

    I/We omit any pertinent information.

    2. I/We have applied for a Loss Mitigation Services from PLC LLC, in applying for the Services, I/Weunderstand, authorize and agree that credit report(s) to be obtained in connection with thisapplication by PLC LLC or a third party provider.

    3. I/We understand and agree that PLC LLC reserves the right to verify the information provided on theapplication with the employer and/or the financial institutions.

    4. I/We fully understand that it is a Federal crime punishable by fine or imprisonment, or both, toknowingly make any false statements when applying for this modification, as applicable under theprovisions of Title 18, United States Code, Section 1014.

    Authorization to Release Information

    To Whom It May Concern:

    1. I/We have applied for a Loss Mitigation Services from PLC LLC as part of theapplication process, PLCLLC may verify information contained in my/our application and in other documents required inconnection with the Loss Mitigation Services, either before the Loss MitigationServices is settled or

    as part of its quality control program.

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    2. A copy of this authorization may be accepted as an original.

    3. I/We do hereby authorize (my lender/mortgage servicer) to release or otherwise provide to The Staffat Protection Law Center to speak included the following, (Samantha Cancel, Eddie Gomez, ClaudiaMarquez and all other PLC LLC staff) public and non-public financial informationcontained in my loanaccount which may include, but is not limited to, loan balances, final payoff, loan payment history,

    payment activity, and/or property information.

    This authorization is valid for One year from the above date and/or until it isremoved in writing by the Borrower(s)or PLC LLC.

    Applicant:

    SSN:

    Date:

    Co-Applicant:

    SSN:

    Date:

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    For SCC use only:

    Loan Number:

    Property Address:

    Date:

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    Scope of Representation

    PLC LLC will provide services for (the Client) for theexpressed and implied purpose of providing the following Loss Mitigation Services andrepresentation (as defined and referred to in the following Description of Servic

    es) for(the Client).

    This agreement and representation is limited to the Loss Mitigation Services fortheaforementioned client and real property address located at (theproperty). PLC LLC is being engaged for the purpose of legal representation in assisting Client withcertain problems resulting from a mortgage delinquency and/or foreclosure situation in connection with

    the property. This representation does not include, E.G., appearances in court,appearances tosettlement conferences, answers of default for summons and complaint, overall representation in theforeclosure action, appeals from any judgments or orders of the court. We will provide these servicesat additional costs to our clients.

    Appeals are subject to separate discussion and negotiation between the Law Firmand you. Thisagreement also does not cover any services you may request in connection with an

    y other matter,action or proceeding.

    The representation you have sought from the Law Firm may be time-consuming. In order to giveyou an understanding of what is involved; the following is our best estimation of the steps involvedin the representation as well as the time frame we expect it will take for the representation toconclude:

    Description of Services provided under this agreement:

    1. Initial Consultation and counseling of clients rights and options regarding their rights,responsibilities, and alternatives in loss mitigation as well as preparing and submitting allloss mitigation paperwork on behalf of the client . We will negotiate to obtainone or moreof the following; negotiate a loan modification offer, short sale negotiation, short refinance

    negotiation , suspension of a foreclosure sale date, deed in lieu of foreclosure, or cash-forkeysnegotiation or loan forbearance offer.

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    2. USE OF COUNSEL LAW FIRMS

    Specifically, as part of this agreement, Friedman Law Associates, PC, has been retained as OFCounsel to PLC. Friedman Law Associates, P.C. has the right to retain local atto

    rneys at theirdiscretion.

    3. Contacting and negotiating with lien holders, creditors etcon your behalf regarding theloan modification, loan restructure, short sale negotiation, short refinance negotiation, ,deed in lieu of foreclosure, or cash-for-keys negotiation, or any suspension offoreclosuresale date.

    4. Negotiation Process:

    A. Initial Consultation and advising client regarding various loss mitigation options.

    B. Document review for various RESPA, Truth in lending and predatory lendingviolations while file structuring and submitting your file to the lender.

    C. Secure Bank authorization to speak on clients behalf.

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    D. Communicating with bank regarding individual clients financials and faxingappropriate documentation to the appropriate department.

    E. Negotiating with loss mitigation and or bank appointed negotiator regarding clients

    file on one of our loss mitigation services or resolutions (I.E. loan modification offer,loan restructure, loan forbearance offer, short sale negotiation , short refinancenegotiation, suspension of a foreclosure sale date, , deed in lieu of foreclosure , orcash-for-keys negotiation: The modification process may vary depending on yourbank, and your current mortgage situation. The process may take a few weeks toseveral months to complete and receive a modification offer. Please note thatyour lender may deny your loan restructure several times before we achieve adesired result.

    F. If you fail to provide us with requested information and documentation whichwillnot permit us to successfully complete services outlined in our service agreementand scope of representation, we will deem our services to have been completed. Iffalse information is provided to our firm which will not permit us to successfullyachieve the services we offer, we will deem our services completed. If you failtocomply with any requests that prohibit our firm from obtaining the services listed,

    we will deem our services completed. If you cancel our services at any time duringthe negotiating process, we will have the right to keep any fees paid to the lawfirmfor services and time allocated to your case at an hourly rate of $300.00 per hour forattorney time and $150.00 per hour for paralegal time. Regardless of the hoursspent on your file, the aggregate fee shall never exceed the service fee listedin thisagreement. These fees are only to apply for services listed in our service agreementand scope of representation.

    G. Please note: PLC LLC does not make any promises on specific rates or terms ofyour loan restructure offer. We at no time recommend homeowners to miss theirmortgage payments at any time.

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    Applicant:

    Date:

    Co-Applicant:

    Date:

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    Service / Retainer Agreement

    The purpose of this letter agreement is to set forth the mutual understandings and agreements

    between you and PLC LLC with respect to the agreement to assist you in loss mitigation services ofyour mortgage recorded on the above-referenced Property (the Services). PLC LLC appreciatesyour confidence in our business and, while we can make no guarantee as to the outcome of yourmatter, we shall keep you generally apprised as to the status of your loss mitigation services. Inturn, you agree to cooperate with PLC LLC so that your matter can be properly handled.

    You agree to be truthful with and fully cooperate with PLC LLC in regard to the

    services outlined inour Scope of Representation. You will provide copies of any and all correspondences received from,including but limited to, the lender, its agents or attorneys, or any involved foreclosure court. Youmust immediately contact PLC LLC if you become aware of any pending foreclosuresale dates,bankruptcies, or any other situation that would impede, hinder, or alter the lawfirms ability torepresent you in the loan modification process. You shall respond to any and allrequests andinquiries made by PLC LLC in a timely manner, not to exceed forty-eight (48) hours from the time of

    request. You agree not to enter into any agreement directly with the lender while PLC LLC is activelyengaged in loan modification services on your behalf. During the pendency of this agreement, anyloan modification or related agreement obtained through the assistance of the law firm or theclients own efforts, will be deemed the efforts of the law firm, and as such, all attorneys fees shallbe considered earned. Your failure to cooperate shall be deemed a breach of thisagreement andtherefore subject to termination.

    PLC LLC will perform all duties it considers necessary an appropriate to complete the services fullyoutlined in our Scope of Representation. You understand that nothing in this agreement nor anyoral or written statements made by PLC LLC is to be construed as a guarantee ofany outcomeconcerning your case. For the purpose of providing you with the best and most comprehensive loanmodification services, PLC LLC., in its discretion, may employ and supervise associate or co-counselattorneys, independent contractors and/or loss mitigation specialists. In exchange for the Servicesprovided by PLC LLC hereunder, you shall pay PLC LLC, a lump-sum retainer equal

    to$_ _____________ for negotiating your first mortgage (Attorneys Fees). For negotiating

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    your second mortgage, You shall pay PLC LLC a lump-sum retainer equal to$_ ___________.(Attorneys Fees) The total amount paid will be$_ _____________________. If PLC LLC is being retained and a property sale dateis Thirty(30) days from the date of this agreement, an additional lump sum retainer in the amount of

    $_____ must be paid, in addition to any other attorney services as written below.

    The Attorneys Fees described above shall be considered a Retainer for attorneys time that isfully earned as services are deemed rendered. Attorney time shall be billed at arate of $300 per hourand Paralegal time shall be billed at a rate of $150 per hour. You expressly authorize PLC LLC. to pay forthe services of associate or co-counsel attorneys, independent contractors and/or loss mitigationspecialists from the Retainer described herein.

    The services provided by PLC LLC are fully outlined in our Scope of Representation which youwill need to sign. Our loss mitigation services may consist of but not limited to, change of interest rate,change of length (term) of loan, a forbearance agreement, waiver of late charges, a change fromadjustable rate to a fixed rate, and a suspension of a foreclosure sale date, submission of loss mitigationpaperwork or any additional services outlined in our scope of representation. Please read our scope ofrepresentation for full service details. Fees shall be payable by electronic checking

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    money order, personal check or bank/official check. No other forms of payment shall be accepted. Inthe event that you fail to cooperate with PLC LLC, or that you provide PLC LLC with inaccurate or falseinformation which prohibits the firm from obtaining one of our loss mitigation services, we have the

    right to retain any amounts already paid to PLC LLC. If you cancel our servicesduring the negotiationprocess, we have the right to retain any amounts already paid towards services.This agreement doesnot cover any appearances in court, appearances to settlement conferences, answers of default forsummons and complaint, representation in the overall foreclosure action, appealsfrom anyjudgments or orders of the court. This agreement does not cover any litigation services, which can beprovided at additional costs to our clients.

    You further agree that, upon execution of this Agreement, PLC LLC at no time hasexpressed orsuggested a refusal in payment concerning any of your financial obligations. I.E. Mortgage, Credit Cards,Personal Loans, Vehicle, Etc.

    RETAINER AGREEMENT:

    Please acknowledge your agreement to the foregoing by countersigning this letter

    agreementand returning such signed copy to the undersigned. This letter agreement may beexecuted in anynumber of counterparts, each of which shall be an original, but all of which together shall constituteone instrument. This Agreement shall be governed, construed and enforced in accordance with thelaws of the State of Florida, without giving effect to principles of conflicts of law. If you would like tocancel our services, you may mail or fax your cancellation letter to PLC LLC orfax to 866.545.2959within 5 business days of signing this contract. You will be entitled to a fullrefund if we receive yourcancellation within the 5 business days. PLC LLC reserves the right to use outside counsel for anyservices outlined in this agreement. If you cancel our services at any time during the negotiatingprocess, we will have the right to keep any fees paid to the law firm for services performed and timeallocated to your case at an hourly rate of $300.00 per hour for Attorneys and $150.00 per hour forParalegals. Regardless of the hours spent on your file, the aggregate fee shallnever exceed the servicefee listed in this agreement. These fees are only to apply for services listed in our service agreement

    and scope of representation.

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    Very truly yours,On behalf of The Protection Law Center LLC

    Name:

    Title:

    Date:

    ACCEPTED AND AGREED TO BY:

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    Applicant:

    Signature:

    Date:

    Co-Applicant:

    Signature:

    Date:

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    Client Attestation Regarding NonGuaranteePolicy

    I/We,

    (Client) hereby understand the following:

    Nothing in this Agreement nor anything in Protection Law CenterLLCs oral or written statements shall be construed or interpreted asa promise of guarantee of any particular outcome concerning

    my/our case or loan modification. PLC LLC makes no such promiseor guarantee of any outcome. I understand that no one can forcemy/our lender(s) to accept any proposed resolution or modificationof my/our loan(s). The Firms acceptance of my/our case is not aguarantee as to the outcome or amounts recoverable in connectionwith my/our claim. I/We understand that PLC LLC is only promisingto render its best professional skill and judgment and use its bestefforts to change my/our current loan situation and has notguaranteed or promised any specific outcome.

    ACCEPTED AND AGREED TO BY:

    Applicant:

    Signature:

    Date:

    Co-Applicant:

    Signature:

    Date:

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    ADDENDUM TO SERVICE AGREEMENT

    I,

    (Client) hereby recognize and

    agree that any loan modification or loss mitigation offer obtained afterthe date of this initial application has been the result of the efforts putforth by the PLC LLC. Therefore, I also agree that I will not receive anyrefund in the event of a mortgage modification offer or loss mitigationoffer is made after this date.

    Please acknowledge your agreement to the foregoing by countersigning this letteragreementand returning such signed copy to the undersigned. This letter agreement may beexecuted in anynumber of counterparts, each of which shall be an original, but all of which together shall constitute oneinstrument. This Agreement shall be governed, construed and enforced in accordance with the laws ofthe State of Florida, without giving effect to principles of conflicts of law.

    Very truly yours,

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    Name:

    Title:

    Date:

    ACCEPTED AND AGREED TO BY:

    Applicant:

    Signature:

    Date:

    Co-Applicant:

    Signature:

    Date:

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    Applicant Name:

    Applicant Address:

    This is to acknowledge that all monies paid to PLC LLC in regards to the services listedin this agreement will be earned pursuant to the following fee summary:

    FEE SUMMARY: PLC LLC offers its services in PHASES. Accordingly, PLC LLCshall be entitled to a fee of $___________upon completion of PHASE 1, $_________upon completion of PHASE 2, unless specified herein, and a final fee of $_________due upon completion of PHASE 3, unless specified otherwise herein. Thearrangement set forth herein is not set forth by law but is negotiable between PLCLLC, Client.and/or.lender/servicer.PHASE 1: Analyze income and expense statement signed by Client, analyze termsof existing loan, analyze loan as compared to fair market value conditions, evaluateClient's hardship as it relates to Client's ability to meet the requirements of

    Clientnote(s), communicate to Client all options for loan modification/resolutions,request from Client primary documentation which will include but is not limitedto:current mortgage coupons for all properties owned by Client, one month recent paystub(s), and a 6 month profit and loss statement (if self-employed).

    PHASE 2: Prepare and submit 3rd party authorization to lender, underwriteClients file pursuant to specific Lender guidelines. Request and accumulateadditional Client documentation. This Client document request will include, butisnot limited to, recently filed tax returns, additional and/or updated paystubs,current W-2's, updated profit and loss schedule (self employed only), rentalagreements (if applicable), personal and/or business bank statements (ifapplicable), utility bills, 4506T form and any other financial information providedto Protection Law Center, LLC by Client that Protection Law Center, LLCdeems material to compliance with lender guidelines, notify Client of any missingor incomplete documents and/or missing information, assist Client in preparinghardship letter (if necessary), analyze, revise and complete final underwritingofClient's loan modification/resolution to ensure documentation will supportmodification created in PHASE 1, confirm receipt of 3rd party authorization with

    Lender, attempt an Attorney/Client.compliance.call,.and.persue.a.loan.modification/resolution.

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    PHASE 3: Submit and confirm receipt of loan modification/resolution withLender, engage in active negotiations with Lender to achieve a loanmodification/resolution, update Client regarding status of negotiations, analyze,review, and if necessary, revise income and expense projections based onsupplemental contradictory information provided by Client or Lender, updateClient regarding any changes in strategy based on a change of Lender guidelines

    and/or Client's inability to provide Lender with proof of income, inform and adviseand update Client of all options regarding loan modification/resolution as outlinein the Scope of Representation/Retainer Agreement and Attorney review of loanmodification/resolution documents and/or terms.

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    Applicant:

    Signature:

    Co-Applicant:

    Signature:

    Applicant Name:

    Applicant Address:

    I am aware that the PLC LLC is only representing me with respect to loss mitigation serviceslisted in the signed scope of representation and service agreement. I understandthat in certainstates I may need to seek outside counsel for any foreclosure actions taken against me. PLC LLCis not responsible for responding to any motion papers, court appearances, settlementconferences or anything relating to any foreclosure actions or bankruptcy filings. PLC LLCinstructs all clients to respond to motions and/or summons and complaints immediately or tohire a law firm to provide these services. Please speak to one of our attorneysfor retaineramounts regarding any additional services or representation.

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    Instructions

    1. Complete the form by printing legibly in dark pen and enter all numbers accurately in

    the provided spaces.

    2. Kindly sign this authorization in designated area.

    I, hereby authorize Protection Law Center, LLC. to make a checkwithdrawal from my checking account listed below.

    Account Name as it appears oncheck:

    Account Holders Address:

    City:

    State:

    Zip:

    Bank Name:

    Bank Address:

    City:

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    State:

    Zip:

    Bank Routing Number (ABA#):

    (The nine numbers usually found before your account number on your bottom of your check)

    Checking Account Number:

    Check Number:

    Please Attach Copy of Voided Check

    Amount of Initial Check: $

    Check #:

    Date of Initial Check:

    If paying on 2-payment plan please supply amount and date for second check:

    Amount of Second Check: $

    Check #:

    Date of Second Check:

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    Amount of Third Check: $

    Check #:

    Date of Third Check:

    (if applicable)

    (if applicable)

    Authorized Signature:

    Date:

    Please Sign Here

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    PROTECTION LAW CENTER

    1620 W. Oakland Park Blvd #200

    Oakland Park, FL 33311

    Tel: 1.888.745.7988 Fax: 1.866.545.2959

    www.theplclaw.com

    Borrower: ____________________________________Last 4 numbers of social:____________________

    Co-Borrower: _________________________________Last 4 numbers of social:____________________

    PropertyAddress:_____________________________________________________________________________

    ______________________________________________Zip Code__________________________

    _____

    Telephone Numbers:____________________________________________________________________

    Lender:______________________________________________________________________________

    Loan Number:_________________________________________________________________________

    Servicer:______________________________________Telephone:______________________________

    PLC Legal

    Assistant:_____________________________________________________________________________

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    I authorize Protection Law Center, LLC and its representatives to speak on my behalf regarding myloan with my lender and with whoever has servicing responsibilities for my loan.

    I also authorize the lender and/or servicers handling my loan discuss my loan with ProtectionLaw Center.

    I authorize Protection Law Center, LLC to pull credit reports to evaluate my credit for lossmitigation purposes.

    I authorize the lender and/ or servicer to notify Protection Law Center, LLC in

    the event that my loanpayments become delinquent in the future, if the lender or servicer chooses to provide this service.

    Borrower Signature:_____________________________

    Date:_____________________________

    Co-Borrower Signature:__________________________

    Date:_____________________________

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    LIMITED POWER OF ATTORNEY

    DEAR SIR OR MADAME:

    This Limited Power of Attorney authorizes all present attorney and legal representatives to furnish full andcomplete legal and financial information, files and documents hereby requested by the undersigned to the

    Protection Law Center

    1620 W. Oakland Park Blvd #200 Oakland Park, Fl 33311

    Phone: 954-640-9356 or to any representative, attorney or investigator from saidlaw firm, pertaining to thefinancial or mortgage information on my home or property located at:

    Name:

    Property:

    Loan Number:

    Social Security Number:

    Protection Law Center Agent: Exp Date___________

    Protection Law Center has been retained to represent me in connection with thefinancial/mortgage loan negotiations of the aforementioned home/property and totake all necessary steps tosecure the business transactions/mortgage loan negotiations thereof. All futureinquiries or correspondenceshould be directed only to the Protection Law Center

    Your full cooperation with my law firm/attorney is requested. You are further requested todisclose no information to any other person without written authority to do so.

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    ALL PRIOR AUTHORIZATIONS ARE HEREBY CANCELLED.

    I hereby certify that:

    The foregoing Instrument was acknowledged before me this ___ day of _______, ______

    By_______________________, who is personally known to me or who has produced _____________as identification.

    ______________________________

    Notary Public

    _____________________________CLIENT (Sign Name)

    ______________________________

    CLIENT (Print Name)

    ______________________________

    DATE

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