Affidavit Regarding Demand For Payment of Worthless Check {SCA-M336NP}

IN THE MAGISTRATE COURT OF COUNTY, WEST VIRGINIA Plaintiff v. Case No. Defendant A FFIDAVIT : R EGARDING D EMAND FOR P AYMENT OF W ORTHLESS C HEC K STATE OF WEST VIRGINIA COUNTY OF , TO - WIT, This day appeared before me, and on his or her oath or affirmation says: 1. I am the plaintiff in the above - styled action. 2. That on (date) , I delivered a written demand for payment of the check(s) by personal service or by certified mail or regular mail (if regular mail is selected complete number 3) with a notice of intent to file a lawsuit pursuant to W.Va. Code 247 55 - 16 - 1 if payment is not received within 30 days. 3. If service was achieved by regular mail, (check one) I have attached a post - marked certificate of mailing or I attest that on a written demand was mailed to the defendant at the following (date) address: 4. Thirty days (30) have now passed, and I have not received full payment of the check debt. Plaintiff222s Signature Taken, subs cribed and sworn or affirmed before me this day of ,20 My Commission expires on . Notary Public/Magistrate Assistant/Magistrate Clerk NOTICE: The intentional filing of a false affidavit may constitute a criminal violation [see e.g., W.Va. Code 247 61-5-3 W. Va. Code 247 55-16-1 Copy Distribution: File Plaintiff SCA-M336NP / 5-02 Docket Code(s): MWAPC Defendant American LegalNet, Inc. www.FormsWorkFlow.com