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

NOTICE OF DISHONORED CHECK Date: ___________________________ To: You are hereby notified that a check or instrument numbered: ___________ , apparently issued by you on ___________________________ [date], in the amount of $ ___________ , drawn upon ___________________________ [name of bank], and payable to ___________________________ , has been dishonored. Pursuant to Indiana law (IC 26 -2-7-1, et seq.), you have 10 days from postmark of this notice to tender payment of the full amount due ($ ___________ ) in order to avoid further liability . If you fail to pay within 10 days, you will owe additional amounts including interest, attorney fees, and other costs and expenses incurred for the collection of the dishonored check. Contact me for the exact amount at [phone] _______ ____ befo re paying. If you fail to pay within 30 days from the postmark on this Notice, you will also be liable for the following: If the face amount of the check is not greater than two hundred fifty dollars ($250.00), three (3) times the face amount of the chec k, -OR - if the face amount of the check is greater than two hundred fifty dollars ($250.00), the face amount of the check plus five hundred dollars ($500.00). Mail or deliver the total amount to the following: Notice Issued by: Signature: _____________ ___________________ Print Name: _______________________ Ti tle: _______________________