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DEBT ACKNOWLEDGEMENT FORM
I, ____________________________________________ the undersigned, hereby confirm and
acknowledge to the following Creditor _____________________________________________
that I am indebted to said Creditor, in the amount of $ ______________________ dollars as of
the below mentioned date. The indebted amount includes any and all legally permitted
charges such as accrued interest, up to that same below mentioned date.
I furthermore acknowledge that I have no argument with said debts which were incurred by
myself, and for which I am solely responsible. This also means that I acknowledge that
there are no defenses should said Creditor decide to use this legal form in a court of law as
a confession to judgment - where legally permissible.
Signed on this _______ day, of the month ______________________in the year ____________.
______________________________________________________
Witness
______________________________________________________
Debtor
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3/28/2013 |
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