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Fill and Sign the Miami Dade County State Attorney Katherine Fernandez Rundle Form

Fill and Sign the Miami Dade County State Attorney Katherine Fernandez Rundle Form

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NOTICE OF DISHONORED CHECK(pursuing civil penalties) Date: ___________________________ To: This statutory notice is provided pursuant to Section 97-19-57 and 11-7-12, Mississippi Code of 1972. You are hereby notified that a check, draft or order numbered ___________, apparently issued by you on ________________, 20___ (date), drawn upon ___________________________ (name of bank), and payable to ___________________________, has been dishonored. Pursuant to Mississippi law, you have fifteen (15) days from receipt of this notice to tender payment of the full amount of such c heck, draft or order, plus a service charge of Thirty Dollars ($30.00), the total amount due being $___________. Failure to pay this amount in full within the time specified above shall be pri ma facie evidence of and create a presumption of both the intent to defraud and the knowl edge of insufficient funds in, or on deposit with, such bank in violation of Section 97-19-55. Make your payment to (name)___________________________ at the following address: Mail or deliver the total amount to the following: Notice Issued by: Signature: ________________________________ Print Name: _______________________ Title: _______________________

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