Georgia > Local County > Effingham > Magistrate Court
Bad Check Application - Georgia
| Bad Check Application Form. This is a Georgia form and can be used in Magistrate Court Effingham Local County . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
BAD CHECK APPLICATION 1. Maker of the Check _______________________________ Phone ( ) _______________ Address _________________________________________________ _________________________________________________ DOB ____________ SOCIAL SECURITY NUMBER: __________________________ RACE ________ HAIR _______ EYES _______ HEIGHT _______ WEIGHT _______ I.D. Marks; scars, glasses, etc. ________________________________________________ PAYEE (Victim) ___________________________________ Phone ( ) ______________ Agent/Manager ___________________________________ Address _________________________________________________ _________________________________________________ Amount of Check $ _______________ Date of Check _________________ Date you received Check? _______________ 2. 3. 4. 5. Date you mailed letter? ________________________________ Was the letter sent certified? ___ YES ___ NO or regular mail ________ If the certified letter was signed for, what was the date letter was signed? ___________ Was the letter returned to you unclaimed, or was it received by the addressee? ____________ Unclaimed _____________ Claimed Was the check presented to the Bank within 30 days of being received? ____ Yes ____ No What consideration was given to the Maker of the check in exchange for the payee to take the check? Example (goods, food, services, etc.) ___________________________ Did exchange of check occur at the same time? ____ Yes ____ No Was Identification produced and documented on the check? ____ Yes ____ No Did the person receiving the check know the maker of the check by name? ____ Yes ____ No Who received the check? ___________________________________________________ Did the person who passed the check do any of the following in the presence of the person who accepted the check? a. Date Check _______ b. Sign Check _______ Why was the check returned to the victim? Insufficient Funds _____ Account Closed _____ 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Other ____________________ The above answers are true to the best of my knowledge and belief. Signature ________________________________________ Date _____________________ American LegalNet, Inc. www.FormsWorkFlow.com
|
|||||||
