Certification # 111 222 333 444 555

Tracer # WS1000

CERTIFIED DEFAULT IN DISHONOR

___________________________________________________
NOTICE TO THE AGENT IS NOTICE TO THE PRINCIPAL
NOTICE TO THE PRINCIPAL IS NOTICE TO THE AGENT
Applicable to all Successors and Assigns

From: Winston Shrout, TTE

Authorized Representative for Respondent/Maker WINSTON SHROUT
C/o Notary Acceptor
123 N 200 E
Anytown, Utah 84xxx

To Alleged Creditor: Utah ABC Bank

123 Upper
Anytown, Utah 84xxx

PLAIN STATERMENT OF FACTS

I, Winston Shrout, TTE, the only authorized representative for Respondent/Maker, WINSTON SHROUT,
having made in good faith a bona fide Presentment/Offer as per “Certified Promissory Note” being registered United
States Post Office, Conditionally Tendered an Offer of Performance, including “verified Actual and Constructive
Notice” with related attachments.
The above referred alleged creditor, has failed/refused to comply ad honor the requisite conditions set forth
in above referred instruments, thereby lapsing into a condition of “Fault in Dishonor” thereby being afforded
opportunity to cure, included therein “Certification of Non-Response” by non-party to this action, Utah state notary
public.
Alleged creditor failed/refused to qualify it’s/their position, in accord with terms of Fault in Dishonor –
Opportunity to Cure; Certification of Non-Response, as such, by and through it’s/their non-response and commercial
dishonor have lapsed into “Default in Dishonor” as enumerated in the instruments set forth below:
1. Certified Promissory Note; Registration # RA 123 456 789 US; Note No.: WS1000 dated 11/12/04.
2. Legal Notice and Caveat, dated: 11/12/04.
3. Memorandum with Points and Authorities.
4. Verified Actual and Constructive Notice; Registration # RA 123 456 789 US; Tracer # WS1000
5. Notice of Fault in Dishonor et seq., dated 12/9/04. Certification # 111 222 333 444 555, Tracer # WS1000.

DEFAULT IN DISHONOR

Alleged Creditor, has failed/refused it’s/their contractual duty and obligation by and through it’s/their non-
response and commercial dishonor, for it’s/their failure/refusal to perform in accord with the terms and conditions
set forth in Respondent/Maker’s offer of performance, conspicuously set forth in above referred “Certified
Promissory Note” (1.), further exhibited in Respondent/Maker’s “Verified Actual and Constructive Notice” (4.).
Alleged Creditor, has failed/refused to come forth in good faith with clean hands, exhibiting it’s/their bad
faith, for it’s/their failure refusal to provide the requisite information and/or documentation, including but not limited
to a verifiable, bona fide expressed contract with Respondent/Maker, and/or “Attorney in Fact”.
Alleged Creditor has failed/refused to make presentment of above referred “certified Promissory Note” in
(1.) of this instrument.
Alleged Creditor has failed/refused to request an extension of time to Respondent/Maker or to non-party in
this action, Utah state notary public, Steve Bradshaw.
Alleged Creditor has unambiguously set forth it’s/their lack of any type of kind or standing, or capacity to
state a bona fide claim, thereby making it’s/their tacit procuration that no debt, duty, obligation exists between
Alleged Creditor with Respondent/Maker, and/or “Attorney in Fact”.
Alleged Creditor has agreed and stipulated to application of “Law of Estoppel, by silence” and
subsequently may not later controvert, rebut, refute any and all facts asserted herein and herewith.
 Alleged Creditor, admits and agrees to being in a state of “Default in Dishonor” thereby constituting a third
(3rd) witness that no verifiable claim or contract exists between Alleged Creditor with the Respondent/Maker and/or
“Attorney in Fact” other than this contractually ratified compulsory counter-claim.
Respondent/Maker by and through “Attorney in Fact” reserves the right to incorporate this “Default in
Dishonor” and related instruments into any financial, commercial, administrative, judicial, non-judicial proceedings,
and to have such instruments entered into the commercial registry.
Respondent/Maker by and through “Attorney in Fact” reserves the right to use this civil assessment to
determine actual damages and loss incurred by and through your and your companies willful and intentional
tortuous acts, actions and omissions to assess actual damages and loss incurred, including but not limited to any and
all treble damages which may arise here from.
This “Certified Default in Dishonor” constitutes the conclusive fact that your company has never had,
cannot have, and do not have any type or kind of verifiable, bona fide claim contract and the like and are acting in a
capacity of tort feasors.

united states of America )

) Affirmed
Utah state )

VERIFIED ACKNOWLEDGEMENT AND JURAT

Personally appeared before me this ____ day of __________ month, 2004, Winston Shrout, TTE, herein
referred “Authorized Representative” for Respondent/Maker “WINSTON SHROUT” and certifies that this
“Certified Default in Dishonor” is made in good faith, and that “Winston Shrout, TTE” has personal, first-hand
knowledge of the facts asservated herein and herewith, is over the age of twenty one years and fully competent to
testify to all matters set forth herein and herewith, and certifies that the facts asseverated herein and herewith are
true, correct, certain and not misleading, the truth, the whole truth and nothing but the truth in law, commerce and
substantial citation, certified under penalty of perjury in accord with the laws of the Utah state and the united states
of America.

By order of: WINSTON SHROUT, Respondent/Maker

_______________________________
Winston Shrout, TTE, the Only Authorized Representative for
Respondent/Maker, Unlimited Liability Capacity, All Rights and Defenses
Reserved Without Prejudice, UCC 1-207

WITNESS my hand and official seal

______________________________
NOTARY PUBLIC