2023 Vermont Debt Adjuster Annual Report

Pursuant to Title 8, Vermont Statutes Annotated, Sections 2120 and 2757a, all debt adjuster licensees must prepare and submit under oath, no later than April 1, 2024, one copy of this report. This report is required whether or not any activity took place during 2023, if none, so state. This report is also required even if you surrendered during 2023 or are not renewing your license for 2024.

If you have any questions or encounter any problems in complying with the above report, please contact this Department at dfr.bnkconsumer@vermont.gov prior to April 1, 2024.

ALL CONTRACT INFORMATION SHOULD INCLUDE

VERMONT ACTIVITY ONLY.

WARNING

This report must be filed by each Vermont Debt Adjuster licensee on or before April 1, 2024. Failure to do so could result in the suspension of the licensee’s license as provided by 8 V.S.A. §2110, and the imposition of a $1,000.00 per month fine, as provided by 8 V.S.A. §2120.

Licensee name*

NMLS Company ID*

Name of Reporting Individual*

Phone Number*

Area CodePhone Number

E-mail*

**Calendar year is January 1st through December 31st**

Number of new contracts during the calendar year*

Number of contracts completed during the calendar year*

Number of contracts cancelled during the calendar year*

Total number of contracts as of December 31*

Total dollar amount of contracts as of December 31*

List all locations in Vermont and outside Vermont where the licensee engages in debt adjustment activities with Vermont residents. *

Comments:

Electronic Signature

By typing his/her first and last name, the undersigned states that he/she has executed the foregoing annual report under Title 8, Chapter 201 of Vermont Statutes Annotated; that he/she has been duly authorized to execute and file such report; and that to the best of his/her knowledge, information, and belief, the report and accompanying materials contain no misstatement of fact and do not omit a called for material fact.

E-Signature (First & Last name)*

Date*

MonthDayYear

2023 Vermont Debt Adjuster Annual Report

VERMONT DEBT ADJUSTER INFORMATION