Notice of Fraud Statement of Dispute (Consumer)
Petitioner’s Name on Residential Mortgage Loan: _____________________________________________
Account # on Residential Mortgage Loan: ___________________________________________________
Notice of Trustee Sale #: _________________________________________________________________
Notice of Trustee Sale Date: ______________________________________________________________
Current Address of Petitioner: Street: _______________________________________________________
City/State/Zip Code: ________________________________
Current Home #: ___________________________________
Current Work #: ___________________________________
Current Cell #: ____________________________________
(Circle one) Past or Current Employer: Street: _______________________________________________
City/State/Zip Code: _______________________________
(Circle one) Past or Current Work #: ________________________________________
Nature of Dispute
Amount of Disputed Loan: $______________________, Date of Dispute: _________________________
Give a brief description of the nature of the disputed fraudulent loan:
On ______________, the assigned loan officer provided false information on form 1003 and
proceeded to submit this information to an affiliate account representative who apparently
conspired with an underwriter to approve said loan based on the fraudulently produced
This process caused the Deed of Trust to be fraudulently executed thus breaching it and ultimately
placing me in a mortgage loan in which I had no ability to repay. These Criminal Enterprise
Activities which were not in Petitioner’s best interest, resulted in the wire transfer of sum
$____________, in order to fund the loan and compensate those involved.
Thus, the Petitioner is requesting that the Deed of Trust be appropriately discharged in the interest
*Please review the following documents*
Loan Application, Deed of Trust, Closing Statement, Truth in Lending and Borrower’s
Petitioner states that he/she did not commit any collusion, fraud, or deceit and did not authorize any other
Person (named above or otherwise) to make any false, misleading or misrepresentations on form 1003,
Borrower’s Uniform Residential Loan Application in connection with the above referenced loan.
That he/she had no prior knowledge of the use of his/her name, employment and/or income history being
used in reference to any loan submission, loan approval, execution of the Deed of Trust or loan funding in
any manner which is not permitted by State and/or Federal Bank/Wire Fraud or Contract laws.
Petitioner agrees to testify and assist the appropriate authorities with any civil or criminal investigation or
prosecution against the party or parties responsible for the unauthorized use of any and all fraudulently
used information on any loan application which bares my seal.
By execution below, Petitioner warrants that the above answers are true and correct and that Petitioner
voluntarily made this Statement.
Furthermore, pursuant to the Fair Debt Collection Practice Act section 809 (b) if consumer notifies the debt
collector in writing… …(a) that the debt, or any portion thereof, is disputed… …the debt collector shall
cease collection of the debt, or any disputed portion thereof, until the debt collector obtains verification of
Petitioner’s Signature: __________________________ (Sealed) Date: ___________________________
STATE OF ______________________________ COUNTY OF __________________________________
Sworn to and subscribed before me on ____________________ day of ______________________, 20___.
Please place Notary stamp below.