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SAMPLE DEBTOR NOTIFICATION LETTER <br /> <br />Rev, 11122/02 <br /> <br />January 1, 2003 <br /> <br />Mr./Ms. <br />2001 Smithway Avenue <br />Anywhere, NC 29999 <br /> <br />Notice of Debt Owed to the Town/City/County of <br />Intention to setoff debt <br />Mr./Ms. <br />Social Security Number: <br /> <br />Dear Mr./Ms. : <br /> <br />(For a single debt of $50 or more) <br /> <br />Our records indicate that you owe the following past due amount to the Town/City/County of <br /> <br />Explanation of Debt Bill Date Date Past Due Past Due Amount <br />Water Service December 2, 2001 $76.55 <br />Interest (12 mos) December 2, 2002 4.59 <br />Total ,Debt $81.14 <br /> <br />(For two or more debts, each of $50 or more) <br /> <br />Our records indicate that you owe the following past due amounts to the Town/City/County of <br /> <br />Explanation of Debt Bill Date Date Past Due Past Due Amount <br />Water Service December 2, 2001 $76.55 <br />Interest (12 mos) December 2, 2002 4.59 <br />Total Debt $81.14 <br /> <br />Explanation of Debt Bill Date Date Past Due Past Due Amount <br />Em. Medical Services December 2, 2001 ...... $50.00 <br />Interest (12 mos) December 2, 2002 3.00 <br />Total Debt $53.00 <br /> <br />3 <br /> <br /> <br />