General 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:
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;
You are advising us that you do not already have an attorney representing you in this
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;
You are not aware of any type of protection order or injunction which prohibits or
otherwise restricts you from directly or indirectly
Contacting the other party OR
Prohibits the other party from contacting or responding to you;
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: (all lowercase)
R ev. 08/24/12


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