Bad Check Complaint Form PDF Details

When businesses or individuals receive a bad check, navigating the aftermath can feel like moving through a labyrinth of uncertainty and frustration. The Los Angeles County District Attorney’s Office offers a beacon of hope through its Bad Check Complaint Form, an instrumental tool designed to streamline the process of addressing these financial wrongdoings. Launched on December 3, 2012, this form is the first step toward potential restitution for victims left in the lurch by bounced checks. Prior to filing, one must ensure the check in question qualifies for the program by meeting specific criteria, such as not being post-dated or part of a loan repayment, ensuring the eligibility of the claim. Essential details, including contact information for both the victim or merchant and the check writer, must be meticulously provided to facilitate communication and the pursuit of justice. A key requirement is the issuance of a 'courtesy notice' to the check writer, allowing them a window to rectify the situation before it escalates to legal action. This approach not only aids victims in their quest for restitution—which can include reimbursement for any bank charges incurred due to the bad check but also underscores the importance of due diligence and the consequences of writing bad checks. The form represents a critical step in bridging the gap between victimization and restitution, embodying the county’s commitment to holding individuals accountable for their financial obligations while providing a structured path for victims to seek relief.

QuestionAnswer
Form NameBad Check Complaint Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesbad check los angeles, los angeles county bad check program, los angeles county bad check restituion program, bad check complaint los angeles county form

Form Preview Example

BAD CHECK COMPLAINT FORM

12/03/2012

Step

1

Confirm Eligibility

LOS ANGELES COUNTY DISTRICT ATTORNEY

Bad Check Program Address:

Bad Check Program Contact:

P.O. Box 86407

(800) 842-0733

- Victim Hotline

Los Angeles, CA 90086-0407

(800) 269-0206

- Check Writer Hotline

For more information: da.lacounty.gov/badcheck.htm

1.

Was check post-dated at the time of acceptance?

Yes

No

Initial_________

2.

Does this matter involve a two-party check?

Yes

No

Initial_________

3.

Was check received as a payment on an loan account?

Yes

No

Initial_________

4.

Were you asked to hold or delay depositing the check(s)?

Yes

No

Initial_________

5.

Does the check involve an extension of credit?

Yes

No

Initial_________

* If any of the above are checked “Yes”, the check is ineligible for the program. See the back page for an ineligible list.

Step

Victim/Merchant Name:__________________________________________________________________________________

2Contact Name: ____________________________________________ Title: ________________________________________

Victim

Victim Contact Information:

Email: ________________________________________________________

Information

(Required)

 

Phone:(______)___________________Fax:(______)__________________

Email and/or fax are required for acknowledgement receipt of check and/or Program communication

Address:________________________________________City:______________________State:______Zip Code:____________

If assessed a bank charge(s) for the attached bad check(s) please state the amount of the bank charge per check

$_________________ (Per California Penal Code 1001.65 (c) you are eligible to be reimbursed up to $15 per check for assessed bank charges.)

Step Check Writer’s Name:_____________________________________________________

3Address:______________________________________________ Apt:______________

Check

City:__________________________________ State:________ Zip Code:___________

Writer

 

Information

Home Phone:(_____)__________________Other Phone:(_____)__________________

Driver’s License # / Other ID #:

____________________________

State:

Date of Birth:

________

_____/______/_____

Other ID: (if applicable)

____________________________

check here

“Courtesy Notice” must be sent to recover the bad check(s) in question. If no attempt has been made, the check may not eligible for prosecution. ( See courtesy notice on back.)

 

Ck. No.

 

Date Passed $ Amount Name of person accepting check

What was the

 

Can the check

Step

 

 

 

 

 

 

(if no longer employed please list manager)

Check for?

 

writer be identified?

4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

Check

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

Information

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address where check was accepted (if different than Step 2):______________________________________________________ (Required)

City:________________________________________ State:_______ Zip Code:____________________

I will not accept direct payment from the check writer after filing this form with the Program. Please refer check writer to (800) 269-0206.

Step

I understand that the check writer has the option to dispute this claim in writing with the Bad Check Program.

 

5

If this complaint form is not completely filled out it may prevent or delay this case from moving forward for prosecution review.

I attest that I have sent courtesy notice to the check writer and after 10 days it remains unpaid.

 

Victim

I have reviewed the filing instructions, I hereby affirm and attest under penalty of perjury, that all information provided on this complaint form is

Verification

true to the best of my knowledge.

 

 

 

 

 

Sign & date

X_________________________________________

________________________________________

_____________________

 

Signature of Person Filing (Required)

Print Name of Person Filing

Date Filed

Staple original or bank-generated substitute

Additional complaint forms are available at: da.lacounty.gov/badcheck.htm

For additional information and complaint forms: da.lacounty.gov/badcheck.htm

Sample “Courtesy Notice”

Date

Dear Check Writer:

You are hereby notified that a check numbered______ in the face amount of $________, issued by you on _________drawn upon

__________ bank, and payable to ___________, has been dishonored. You have 10 days from receipt of this notice to tender payment of the

full amount of such check plus a service charge of $_______, the total amount due being $_________.

Unless this amount is paid in full within the time specified above, we may turn over the dishonored check and all other available information relative to this incident to the District Attorney’s Office for potential criminal prosecution.

Closing,

Your name/address

Bad Check Program Information

As a victim of a bad check you may file this form with the Los Angeles County District Attorney, provided there is sufficient information, and that the check meets all eligibility guidelines. The Los Angeles County District Attorney’s Office will seek full restitution for victims whenever possible; however, please keep in mind that the Bad Check Restitution Program can make no recovery guarantees. By submitting the check to the program you surrender control of the check to criminal process and forego the opportunity to pursue civil debt collections.

Check writers are encouraged to make payments in full. Should a partial payment be received, the payment will be allocated between the victim and the Bad Check Program. “Restitution” refers to the face value of all checks listed on this report along with all “stated” bank charges assessed by your bank.

The following types of checks are ineligible for the program:

*Two-party checks

*Partially re-paid checks

*Fraudulent or stamped lost/stolen/forged

*Payroll, credit card or rent checks

*Post/pre dated or altered checks

*Checks you agreed to hold before depositing

*Checks passed outside of Los Angeles County

*Checks which are repayment of loan or civil contract agreement

What to do after my complaint form is filed with the Program

Please do not accept direct payments from check writers. Should the check writer contact you to make payment, refer them to the Check Writer Hotline at (800) 269-0206

You may contact Victim Services for case updates at (800) 842-0733 anytime.

Please allow a minimum of 90 days to pursue restitution.

If the check writer does not comply with the Program, the case may be reviewed for possible criminal prosecution.

If we are unable to recover restitution and/or the check is not “eligible” for prosecution, you may request the check(s) be returned to pursue a civil remedy.

Filing Instructions

1.Fill out Complaint Form completely.

2.Attach checks or legal copies of all checks (front and back side of checks) and all supporting documents such as CERTIFIED MAIL RETURN RECEIPT OR UNDELIVERED LETTER, COPY OF “COURTESY NOTICE,” “RETURN ITEM” NOTICE FROM THE BANK (WITH FEES).

3.Mail Bad Check Complaint Form and all other correspondence to:

Los Angeles County Bad Check Restitution Program

P.O. Box 86407, Los Angeles, CA 90086-0407

4.Once a report has been filed: ALL restitution payments must be coordinated by the District Attorney’s Office. Should the check writer contact you to make payment, direct them to the Bad Check Restitution Program at (800) 269-0206.

DO NOT ACCEPT PAYMENT DIRECTLY FROM CHECK WRITER.

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How to prepare bad check complaint form los angeles step 1

2. Once the last part is complete, you should add the required particulars in Check Writer, Information, Check Writers Name Address Apt, Drivers License Other ID State, Courtesy Notice must be sent to, Can the check, e r e h, k c e h c e t u t i t s b u s d e, i g i r o, e l p a t S, Step, Check, Information, Step, and Victim so you can progress to the next part.

e l p a t S, Check, and Information of bad check complaint form los angeles

3. The following segment is focused on Date Dear Check Writer You are, Bad Check Program Information, As a victim of a bad check you may, The following types of checks are, Twoparty checks Payroll credit, Partially repaid checks Postpre, and Fraudulent or stamped - fill in each one of these blank fields.

bad check complaint form los angeles writing process clarified (stage 3)

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