Fill and Sign the Colorado Notice of Dishonored Check Civil Keywords Bad Check Bounced Check Form

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 Colorado law (Colorado Revised Statutes §13 -21 -109), you have fifteen (15) days from receipt of this notice to tender payment of the total amount of the check, plus the a pplicable service charge (not to exceed $20.00 per check) in the amount of $ ___________ , plus collec tion costs of a person or entity licensed as a collection agency (if used) in the amount of $___________ (no more than 20% the face value of the check), the total amount due being $ ___________ . Unless this amount is paid in full within fifteen days after the date notice was given, you may be liable in a civil action for three times the face amount of the check but not less than one hu ndred dollars as well as court costs and reasonable attorney fees. In addition, the dishonored check(s) or instrument(s) and all other available information relating to this incident may be turned over to the prosecuting attorney for criminal prosecution. Mail or deliver the total amount to the following: Notice Issued by: Signature: ________________________________ Print Name: _______________________ Title: _______________________