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Get ID Notification of Agents/Collectors

GAVIN M. GEE STATE OF IDAHO DEPARTMENT OF FINANCE DIRECTOR IDAHO COLLECTION AGENCY ACT NOTIFICATION OF AGENTS/COLLECTORS DATE NAME OF LICENSEE NEW APPLICATION o Check if this is submitted with a new application QUARTERLY REPORT New Agents LICENSE NO. YEAR If there are NO new or terminated agents for the quarter please check the box below STREET JUN 15 CITY STATE ZIP SEP 15 DEC 15 ANNUAL REPORT All Active Agents MARCH 15 20 NAME OF SIGNATOR Print clearly SIGNATURE Applicant/Licensee agrees to be responsible under Title 26 Chapter 22 Idaho Code for acts of Agent s while said Agent s is employed by the Licensee. Licensee certifies that Agent s has been instructed as to the requirements of the Idaho Collection Agency Act and the Fair Dept Collection Practices Act and that Agent s has a reasonable understanding and will comply with same. DISCLOSURES IF YES THE AGENT MUST SUPPLY A SIGNED DETAILED WRITTEN EXPLANATION ALONG WITH SUPPORTING COURT DOCUMENTS* COMPLETE COLUMN B - within the past ten 10 years have you been convicted of or plead guilty or nolo contendere no contest in a domestic foreign or military court to any felony Collection Credt Repair Debt/Credit Counseling Debt Buying Financial Services or a Financial Services related business C D E GROUP BY LOCATION CITY STATE OF OFFICE SOCIAL SECURITY OR EQUIVALENT F G H I DATE OF TERM HIRE DATE BIRTH DATE DESK NAME IF USED mm/dd/yy CONSUMER FINANCE BUREAU P O BOX 83720 BOISE ID 83720-0031 KAREN*CARLYLE FINANCE*IDAHO. GOV J 20 FEE PLEASE TYPE THE AGENT NAME Alphabetical Order by Location LAST FIRST M B If Yes for Misdemeanor A for Felony Listing Order List Newly Hired Agents first then list all newly terminated Agents on Quarterly Reports. YEAR If there are NO new or terminated agents for the quarter please check the box below STREET JUN 15 CITY STATE ZIP SEP 15 DEC 15 ANNUAL REPORT All Active Agents MARCH 15 20 NAME OF SIGNATOR Print clearly SIGNATURE Applicant/Licensee agrees to be responsible under Title 26 Chapter 22 Idaho Code for acts of Agent s while said Agent s is employed by the Licensee. Licensee certifies that Agent s has been instructed as to the requirements of the Idaho Collection Agency Act and the Fair Dept Collection Practices Act and that Agent s has a reasonable understanding and will comply with same. Licensee certifies that Agent s has been instructed as to the requirements of the Idaho Collection Agency Act and the Fair Dept Collection Practices Act and that Agent s has a reasonable understanding and will comply with same. DISCLOSURES IF YES THE AGENT MUST SUPPLY A SIGNED DETAILED WRITTEN EXPLANATION ALONG WITH SUPPORTING COURT DOCUMENTS* COMPLETE COLUMN B - within the past ten 10 years have you been convicted of or plead guilty or nolo contendere no contest in a domestic foreign or military court to any felony Collection Credt Repair Debt/Credit Counseling Debt Buying Financial Services or a Financial Services related business C D E GROUP BY LOCATION CITY STATE OF OFFICE SOCIAL SECURITY OR EQUIVALENT F G H I DATE OF TERM HIRE DATE BIRTH DATE DESK NAME IF USED mm/dd/yy CONSUMER FINANCE BUREAU P O BOX 83720 BOISE ID 83720-0031 KAREN*CARLYLE FINANCE*IDAHO. .

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