Printable Bad Check Complaint Form in PDF Customize Bad Check Complaint Here

Printable Bad Check Complaint Form in PDF

The Bad Check Complaint Form is a crucial document designed to assist victims in reporting and seeking restitution for dishonored checks. By submitting this form to the Los Angeles County District Attorney’s Office, individuals can initiate the process of recovering funds lost due to bad checks. Understanding the eligibility criteria and the steps involved is essential for ensuring that the complaint is processed effectively.

Customize Bad Check Complaint Here
Overview

The Bad Check Complaint form is an essential tool for individuals and businesses in Los Angeles County who have fallen victim to the issuance of a bad check. This form allows victims to report the incident to the Los Angeles County District Attorney’s Office, initiating a process aimed at recovering the funds lost due to the bad check. Before completing the form, it is crucial to confirm eligibility by answering a series of preliminary questions, such as whether the check was post-dated or involved a loan account. Each question must be carefully considered, as answering "yes" to any of them may render the check ineligible for the program. The form requires detailed information about both the victim and the check writer, including names, contact information, and specifics about the transaction. Victims must also provide documentation of any bank charges incurred due to the bounced check, as they may be eligible for reimbursement. Additionally, the form includes a verification section, where the individual filing the complaint affirms the accuracy of the information provided. Understanding the instructions and ensuring that all necessary details are included is vital, as incomplete submissions may delay or prevent prosecution. This comprehensive process not only facilitates restitution efforts but also helps deter future incidents of bad checks in the community.

Dos and Don'ts

When filling out the Bad Check Complaint form, there are important steps to follow to ensure your submission is complete and accurate. Here’s a list of things you should and shouldn’t do:

  • Do confirm your eligibility before filling out the form. Ensure that the check does not fall into any ineligible categories.
  • Do provide accurate and complete contact information for both yourself and the check writer. This will facilitate communication.
  • Do attach all necessary documentation, such as copies of the checks and any correspondence related to the bad check.
  • Do send a courtesy notice to the check writer before filing the complaint, as this is often a required step.
  • Do review the form for any missing information before submitting it. Incomplete forms may delay the process.
  • Don’t accept direct payments from the check writer after filing the form. This can complicate the prosecution process.
  • Don’t submit checks that are post-dated, two-party, or otherwise ineligible for the program.
  • Don’t forget to keep a copy of the completed form and all documents for your records.
  • Don’t assume that the Bad Check Program guarantees recovery. Understand the limitations of the program before proceeding.

By following these guidelines, you can help ensure a smoother process when dealing with bad checks.

Misconceptions

When dealing with the Bad Check Complaint form, there are several misconceptions that can lead to confusion. Understanding these can help ensure a smoother process for all involved.

  1. All bad checks are eligible for the program. Many people assume that any bad check can be submitted. However, checks that are post-dated, two-party, or involve loans are not eligible.
  2. You can accept payment directly from the check writer. Once you file the complaint, you must refer the check writer to the Bad Check Program hotline instead of accepting payments yourself.
  3. Filing the form guarantees recovery of funds. While the program aims to help recover funds, there are no guarantees that restitution will be achieved.
  4. Only businesses can file a complaint. Individuals can also file complaints if they have received a bad check, not just merchants or businesses.
  5. It’s okay to delay filing the complaint. Timeliness is crucial. Delaying can affect the ability to pursue prosecution or restitution.
  6. Incomplete forms will still be processed. If the form is not filled out completely, it may prevent or delay your case from moving forward.
  7. All types of checks are treated the same. Different types of checks have different eligibility criteria. For example, payroll checks and altered checks are not eligible for the program.
  8. You don’t need to send a courtesy notice. Sending a courtesy notice is a required step before filing the complaint. Failure to do so may affect eligibility.
  9. Once filed, you have no further responsibilities. After filing, you should stay in contact with the program for updates and be prepared to provide additional information if needed.

By clearing up these misconceptions, you can better navigate the Bad Check Complaint process and enhance your chances of recovering your funds.

More PDF Forms

Form Attributes

Fact Name Details
Program Eligibility The Bad Check Complaint Form is for victims of bad checks in Los Angeles County who meet specific eligibility criteria.
Contact Information Victims can contact the Bad Check Program at (800) 842-0733 for assistance and updates.
Initial Checks Victims must confirm if the check was post-dated, a two-party check, or involved a loan payment, among other criteria.
Bank Charge Reimbursement Victims may be reimbursed up to $15 per check for bank charges under California Penal Code 1001.65 (c).
Courtesy Notice Requirement A courtesy notice must be sent to the check writer before filing the complaint to initiate prosecution.
Filing Instructions The complaint form must be completed fully and submitted with all required documentation, including copies of checks.
Restitution Process The program seeks restitution but cannot guarantee recovery for victims.
Ineligible Checks Checks that are two-party, altered, or related to loans are ineligible for the program.

Document 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.

Similar forms

  • Small Claims Complaint Form: Like the Bad Check Complaint form, the Small Claims Complaint form is used to initiate legal action for unpaid debts. Both forms require detailed information about the parties involved, the amount owed, and the nature of the transaction. They serve as a starting point for seeking restitution through the legal system.

  • Demand Letter: A Demand Letter is similar in purpose to the Bad Check Complaint form, as both aim to resolve financial disputes. While the Bad Check Complaint is a formal submission to a legal authority, a Demand Letter is a direct request from the creditor to the debtor, outlining the amount owed and the consequences of non-payment.

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  • Notice of Dishonor: This document notifies the check writer that their check has been rejected by the bank, similar to the initial steps in the Bad Check Complaint process. Both documents serve to inform the check writer of their obligation to pay and the potential legal consequences if they do not.

  • Affidavit of Service: An Affidavit of Service is used to confirm that legal documents have been delivered to the appropriate party, much like the requirements outlined in the Bad Check Complaint form. Both documents emphasize the importance of proper notification to ensure that all parties are aware of the ongoing legal proceedings.

  • Creditors' Rights Complaint: This form is utilized when creditors seek to enforce their rights against debtors. Similar to the Bad Check Complaint form, it outlines the creditor's claims and the basis for seeking recovery. Both forms aim to facilitate the collection of debts through legal means.