Fill and Sign the Kansas 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 Kansas law (Kansas Statutes §60 -2610), you have fourteen (14) days from receipt of this notice to tender payment of the total am ount of the check or instrument, plus a service charge of $ ___________ , plus the cost of this restr icted mailing to you of $ ___________ , the total amount due being $ ___________ . This amount is due by the ____ day of _______________ , 20 ___ . If the money is not paid within fou rteen (14) days, you may be liable for treble damages in addition to the amount of the check, incurred court costs, service charges, costs of mailing and costs of collection, including attorney’s fees. An estimated total of the total amount which may be i ncurred if the amount due is not paid by the date stated above is $ _________ . The dishonored check or instrument and all other available information relating to this incident may also 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: _______________________