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Fillable Printable Template Authorization Letter

Fillable Printable Template Authorization Letter

Template Authorization Letter

Template Authorization Letter

General Authorization Letter
Dear LegalShield Member:
You asked this office to send a letter on your behalf in the legal matter indicated on the next page.
Before we will send the letter, we need the following additional information from you and your
signed authorization that the letter may be sent:
1. If your claim is for money, you certify to the best of your knowledge and belief the
person/business owes you the amount you are demanding herein;
2. You are advising us that you do not already have an attorney representing you in this
matter;
3. You did not receive any written or oral notice from the opposing party/business nor from
any attorney indicating the opposing party filed for bankruptcy protection;
4. You are not aware of any type of protection order or injunction which prohibits or
otherwise restricts you from directly or indirectly
(A) Contacting the other party OR
(B) Prohibits the other party from contacting or responding to you;
5. You already made a demand for payment from the opposing party and such demand was
unsuccessful (if you are claiming money owed to you or your business as a result of a
business/commercial transaction with the person, and the person is an individual, not
another business) and you are not aware the opposing party is represented by an attorney
for this matter.
Please Note: If you would like your letter sent via Certified Mail - Return Receipt Requested,
please remit $15.00 for postage and handling fee. (If you intend to pursue your claim in
Small Claims Court, then sending the letter by Certified Mail - Return Receipt Requested,
is, in our opinion, necessary.)
Please return form to:
Dempsey, Roberts & Smith, Ltd.
1130 Wigwam Parkway Fax: (702) 388-2519
Henderson, Nevada 89074 E-mail: nvdocs@drsltd.com (all lowercase)
Rev. 08/24/12
*** BEFORE WE WILL SEND A LETTER ***
EACH ITEM MUST BE COMPLETELY FILLED IN AND THIS FORM SIGNED
NAME: INTAKE #:
ADDRESS:
MEMBERSHIP #: PHONE #: FAX:
E-MAIL:
Please issue a letter to the below named individual or business based upon the information provided below:
1. Full Name of Opposing Party:
.
2. Opposing Party's Complete Address including zip code (if a business, we require full name if Opposing
Party Representative and/or Owner):
.
3. A brief & legible description of the facts that give rise to the need for this letter (please give dates and
details of the occurrence, use separate sheet of paper if necessary):
.
4. The demand that you wish for us to make on the Opposing Party (NOTE: if this is a demand for
damages, please specify the TOTAL amount and how it was computed; principal, interest, repairs, costs
of completion, etc.):
.
Signature: Date:
This GAL does not apply to enforcing lien rights, since specific time frames and procedures may apply. If specific lien rights
you want to enforce, you must contact this office to discuss how to protect and enforce your lien, or you may lose your rights.
Please attach photocopies of any supporting documents up to 10 pages, i.e., contract, prior letters, invoices.
(DO NOT SEND YOUR ORIGINALS.)
G YES G NO Please send DRAFT for my review before mailing final.
Please select your preference: G Fax G U.S. Mail G E-mail
Rev. 08/24/12
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