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Fill and Sign the Bad Check Affidavit Hill County Montana Form

Fill and Sign the Bad Check Affidavit Hill County Montana Form

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NOTICE OF DISHONORED CHECK Date: ___________________________To: You are hereby notified that Check No. ___________, dated ___________ in the amount of ___________, drawn upon ___________ and payable to ___________ has been dishonored for the reason of ________________. Pursuant to Alaska State law (AS 09.68.115), you have fifteen (15) days from receipt of this notice to tender payment of the total amount of the check, plus costs of $ ___________ (not to exceed $25.00 per check), the total amount due being $___________. If you fail to make payment and suit is commenced against you, you may also be liable for damages in an amount equal to $100.00, or triple the amount of the check, whichever is greater, such damages not to exceed the amount of the check by more than $1,000.00. Notice Issued by:Signature: ________________________________Print Name: _______________________Title: _______________________Mail or deliver the total amount to the following:

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