Fill and Sign the Seeking Criminal Penalties Form

NOTICE OF DISHONORED CHECK (seeking criminal penalties) 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 Montana Code §45-6-316, you have five (5) days from receipt of this notice to tender payment of the total amount of the check or instrument, the total amount due being $___________. Failure to pay the above amount within the period specified may also result in following penalties:A person convicted of issuing a bad check shall be fined not to exceed $1,000 or be imprisoned in the county jail for any term not to exceed 6 months, or both. If the offender has engaged in issuing bad checks that are part of a common scheme or if the value of any property, labor, or services obtained or attempted to be obtained exceeds $1,000, the offender shall be fined not to exceed $50,000 or be imprisoned in the state prison for any term not to exceed 10 years, or both. Montana Code § 45-6-316(3) .Make full payment to ___________________________, at the following address:Mail or deliver the total amount to the following: Notice Issued by:Signature: ________________________________Print Name: _______________________Title: _______________________