WORTHLESS CHECK INSTRUCTION SHEET -------------------------------------------------------------------- 1. If you or the person who received the check cannot positively identify the maker, please do not proceed. No criminal prosecution can be initiated without positive identification of the maker and/or passer of the check. Additionally, there can be no criminal prosecution on the following types of checks: * stop payment checks * post-dated checks * pre-dated checks * mailed checks * checks put into a drop box * checks slid under a door * checks passed outside of the prosecutor's jurisdiction checks for past indebtedness * checks representing payments on charge accounts * checks on credit transactions * rent checks * third-party checks * checks drawn on Canadian banks * checks on which a partial payment has been made * checks for which there is a written repayment agreement 2. Check to insure that this packet contains the following forms: (1) THIS INSTRUCTION SHEET; (2) DEMAND FOR PAYMENT FORM (3) DUPLICATE OF DEMAND FOR PAYMENT FORM PLUS AFFIDAVIT OF SERVICE BY MAIL; (4) REQUEST FOR CRIMINAL ACTION. 3. Complete a separate REQUEST FOR CRIMINAL ACTION form for each worthless check. 4. Complete the DEMAND FOR PAYMENT forms in duplicate and keep one copy. (Copy provided in packet) 5. Mail the DEMAND FOR PAYMENT to the check writer's last known address. (We suggest with a copy of the check attached) 6. Either complete the AFFIDAVIT OF SERVICE BY MAIL or purchase a CERTIFICATE OF MAILING from the post office and attach it to your copy of the DEMAND FOR PAYMENT. (Your signature must be notarized on the AFFIDAVIT OF SERVI E BY MAIL) Without one of these, no criminal prosecution can proceed. 7. If you do not receive payment after 15 days from mailing the DEMAND FOR PAYMENT and you wish to pursue criminal prosecution, fill out the REQUEST FOR CRIMINAL ACTION form. 8. Attach a copy of the DEMAND LETTER and your AFFIDAVIT OF SERVICE BY MAIL or CERFIFICATE OF MAILING to the REQUEST FOR CRIMINAL ACTION form. 9. Submit the entire packet referred to in number 8 above, plus the original check, to the proper law enforcement office. For a check passed in the City of Detroit Lakes, take the entire packet to the Detroit Lakes Police Department; if passed in Lake Park or Frazee, take the packet to that respective police department. If the check was passed outside of those three cities, take the entire packet to the Becker County Sheriff's Department. This must be done within six (6) months of the date on the check, other-wise the check will be considered too old for prosecution. 10. Once a check is turned over for prosecution, you cannot accept payment from the check writer. All payments need to be handled through the Court. The prosecutor's office may decline to prosecute future checks submitted by a business or individual that makes a practice of accepting payment after submitting the checks for prosecution. NOTE: These forms are drawn to meet the requirements of the Detroit Lakes, Lake Park, and Frazee City Attorneys and the Becker County Attorney. --------------------------------------------------------------------- FORM 1, page 2 of 2 Revised 5/22/97 --------------------------------------------------------------------- DEMAND FOR PAYMENT OF DISHONORED CHECK (This form is mailed to the check writer) Dated:________________________________ To:__________________________________________________________________ Address shown on check:______________________________________________ City, State, zip:________________________________ YOU ARE HEREBY NOTIFIED that a check dated _______________________ drawn on the ______________________________________ Bank of ____________________________________ in the amount of $__________ bearing the signature of____________________________________________, (a copy of which is attached) has been returned unpaid with the notation that payment has been refused because of _______________________________. Your attention is called to the laws of the State of Minnesota with reference to checks, extracts of which laws appear below, and DEMAND IS HEREBY MADE FOR THE PAYMENT OF THE ABOVE MENTIONED CHECK, in accordance with the law which requires that unless payment in full of this check is made within FIVE (5) business days after the mailing of this demand, YOUR CHECK WILL BE REFERRED TO THE AUTHORITIES FOR PROSECUTION AND YOUR BANK WILL BE LEGALLY AUTHORIZED TO RELEASE TO THE UNDERSIGNED AND THE PROSECUTING AUTHORITIES INFORMATION RELATING TO YOUR ACCOUNT (DO NOT MAIL CASH). Signed:__________________________________________________ Send payment to:_____________________________________________________ Address._____________________________________________________________ City:______________________________________________ State:________________________ Zip:__________ EXTRACTS FROM MINNESOTA STATUTES RELATING TO CHECKS SECTION 609.535, Subd. 2. Acts Constituting. Whoever issues a check, which at the time of issuance, the issuer intends shall not be paid, is guilty of issuing a dishonored check and may be sentenced as provided in subdivision 2a. In addition, restitution may be ordered by the court. --------------------------------------------------------------------- FORM 2, page I of 2 Revised 5/1/97 --------------------------------------------------------------------- SECTION 609.535, Subd. 2a. Penalties. (a) A person who is convicted of issuing a dishonored check under subdivision 2 may be sentenced as follows: (1) To imprisonment for not more than one year or to payment of a fine f not more than three thousand dollars ($3,000), or both, if the value of the dishonored check or checks aggregated under paragraph (b) is more than $250; or (2) to imprisonment for not more than 90 days or to payment of a fine of not more than $700, or both, if the value of the dishonored check, or checks aggregated under paragraph (b), is not more than $250. (b) In a prosecution under this subdivision, the value of dishonored checks issued by the defendant in violation of this subdivision within any six-month period may be aggregated and the defendant charged accordingly in applying this section. When two or more offenses are committed by the same person in two or more counties, the accused may be prosecuted in any county in which one of the dishonored checks was issued for all of the offenses aggregated under this paragraph. SECTION 609.535, Subd. 3. Proof of intent. Any of the following is evidence sufficient to sustain a finding that the person at the time the person issued the check intended that it should not be paid: (1) proof that, at the time of issuance, the issuer did not have an account with the drawee; (2) proof that, at the time of issuance, the issuer did not have funds or credit with the drawee and that the issuer failed to pay the check within five business days after mailing of notice of nonpayment or dishonor as provided in this subdivision; or (3) proof that, when presentment was made within a reasonable time, the issuer did not have sufficient funds or credit with the drawee and that the issuer failed to pay the check within five business days after mailing of notice of nonpayment or dishonor as provided in this subdivision. --------------------------------------------------------------------- FORM 2, page 2 of 2 Revised 5/22/97 --------------------------------------------------------------------- DEMAND FOR PAYMENT OF DISHONORED CHECK (Fill out and keep this as a duplicate for prosecution) To:_______________________________________________________ Dated:__________________ Address shown on check:______________________________________________ City, State, zip:____________________________________________________ YOU ARE HEREBY NOTIFIED that a check dated __________________________________ drawn on the ___________________________________ Bank of _______________________________________ in the amount of _____________ bearing the signature of _____________________________________, (a copy of which is attached) has been returned unpaid with the notation that payment has been refused because of ______________________________. Your attention is called to the laws of the State of Minnesota with reference to checks, extracts of which laws appear below, and DEMAND IS HEREBY MADE FOR THE PAYMENT OF THE ABOVF, MENTIONED CHECK, in accordance with the law which requires that unless payment in full of this check is made within FIVE (5) business days after the mailing of this demand, YOUR CHECK WILL BE REFERRED TO THE AUTHORITIES FOR PROSECUTION AND YOUR BANK WILL BE LEGALLY AUTHORIZED TO RELEASE TO THE UNDERSIGNED AND THE PROSECUTING AUTHORITIES INFORMATION RELATING TO YOUR ACCOUNT (DO NOT MAIL CASH). Signed:______________________________________________ Send payment to:_____________________________________________________ Address:_____________________________________________________________ City:___________________________________________ State:______________Zip:_______________ EXTRACTS FROM MINNESOTA STATUTES RELATING TO CHECKS SECTION 609.535, Subd. 2. Acts Constituting. Whoever issues a check, which at the time of issuance, the issuer intends shall not be paid, is guilty of issuing a dishonored check and may be sentenced as provided in subdivision 2a. In addition, restitution may be ordered by the court. --------------------------------------------------------------------- FORM 3, page 1 of 3 Revised 5/22/97 --------------------------------------------------------------------- SECTION 609.535, Subd. 2a. Penalties. (a) A person who is convicted of issuing a dishonored check under subdivision 2 may be sentenced as follows: (1) To imprisonment for not more than one year or to payment of a fine of not more than three thousand dollars ($3,000), or both, if the value of the dishonored check ol checks aggregated under paragraph (b) is more than $250; or (2) to imprisonment for not more than 90 days or to payment of a fine of not more than $700, or both, if the value of the dishonored check, or checks aggregated under paragraph (b), is not more than $250. (b) In a prosecution under this subdivision, the value of dishonored checks issued by the defendant in violation of this subdivision within any six-month period may be aggregated and the defendant charged accordingly in applying this section. When two or more offenses are committed by the same person in two or more counties, the accused may be prosecuted in any county in which one of the dishonored checks was issued for all of the offenses aggregated under this paragraph. SECTION 609.535, Subd. 3. Proof of intent. Any of the following is evidence sufficient to sustain a finding that the person at the time the person issued the check intended that it should not be paid: (1) proof that, at the time of issuance, the issuer did not have an account with the drawee; (2) proof that, at the time of issuance, the issuer did not have funds or credit with the drawee and that the issuer failed to pay the check within five business days after mailing of notice of nonpayment or dishonor as provided in this subdivision; or (3) proof that, when presentment was made within a reasonable time, the issuer did not have sufficient funds or credit with the drawee and that the issuer failed to pay the check within five business days after mailing of notice of nonpayment or dishonor as provided in this subdivision. --------------------------------------------------------------------- FORM 3, page 2 of 3 Revised 5/22/97 --------------------------------------------------------------------- AFFIDAVIT OF SERVICE BY MAIL Complete this form upon mailing of original DEMAND and attach it to the prosecution copy of the Demand for Payment) _________________________________, being first duly sworn, deposes (name) and says that on ___________________he/she served the attached DEMAND FOR PAYMENT (date) OF DISHONORED CHECK form upon_____________________________________ (name of individual who signed the check) by placing a true and correct copy thereof in an envelope addressed as follows: Name:________________________________________________________________ Adress:______________________________________________________________ City:_______________________________________ State:_________ Zip:___________ which is (the last known address of said individual) (the address printed on the check) and depositing the same, with postage prepaid, in the United States mail at_____________________, Minnesota. Signature___________________________________________ Subscribed and sworn to before me this_____day of ______, 199____. ____________________________ Notary Public _______________County, Minnesota My commission expires:___________ --------------------------------------------------------------------- FORM 3, page 3 of 3 Revised 5/22/97 --------------------------------------------------------------------- REQUEST FOR CRIMINAL ACTION ON BAD CHECK All of the following questions must be answered unless otherwise indicated. A separate Request form must be completed for each check. Please print or type. If insufficient space is provided, complete your answers on the reverse side. Prosecution of worthless checks requires that you or an employee is ble to positively identify the person who passed the check. If you or an employee cannot positively identify the suspect, do not continue. There will be no prosecution without identification. If you do not personally know the person who passed the check, there will be no prosecution unless you have obtained from the issuer of the check at the time that you received it, at least one fon-n of identification containing the issuer's picture. The issuer's driver's license number or state identification card number must be obtained and written on the check (or preprinted on the check) at the time you receive it. Reason for return by bank: NSF_________Acct closed_________ Other____________________________ Check #___________________Amount of check $__________ Acct No.___________________________ Dated______________________ Payable to________________________________________________ Name of person who signed check______________________________________ Name of account holder if different from check maker_________________ Name, city, state of bank which dishonored check_____________________ _____________________________________________________________________ 1 . Your name & address:___________________________________________ 2. Phone (home) ______________________________ (work)______________________________ 3. Name and address of firm you represent (if applicable): _______________________________________________________________ ______________________________________________________________ 4. Please list the names, addresses and phone numbers of persons who can identify the person who wrote the check: _______________________________________________________________ 5. Name and address of person who received the check: _______________________________________________________________ _______________________________________________________________ --------------------------------------------------------------------- FORM 4, page I of 3 Revised 5/22/97 --------------------------------------------------------------------- 6. Names and addresses of persons who witnessed the transaction: ____________________________________________________________ ____________________________________________________________ 7. Can the person who received the check personally identify the party who signed and/or presented the dishonored check ? Yes _________ No_________ 8. If yes, explain how that person knows the suspect. (i.e. know personally, casual acquaintance, regular customer, etc.) ____________________________________________ 9. What form of identification was required when accepting this check? (Social Security card or number is not adequate). _____________________________________________________________ 10. Was the picture on the ID compared to the person who wrote the check? Yes _________ No_________ 11. If so, did the picture ID match the person who wrote the check? Yes _________ No_________ 12. Is the party who signed the check (if a business account) an authorized employee, owner or officer? Yes _________ No_________ Unknown___________________ 13. Party's address:_____________________________________________ 14. Party's employer (if known):_________________________________ 15. Name, address and phone number of person who passed or gave the check if different from above:___________________________ _____________________________________________________________ 16. Date check was actually written:_____________________________ 17. Date check passed to or received by you:_____________________ 18. Date check presented to your bank for payment: _______________ 19. Address where check was written:_____________________________ 20. Address where check was passed or received:___________________ --------------------------------------------------------------------- FORM 4, page 2 of 3 Revised 5/22/97 --------------------------------------------------------------------- 21. What was check in payment of? (i.e. goods/services) Describe:_____________________________________________________ ______________________________________________________________ 22. If check was given to pay for goods or services, did the party receive these goods and services? Yes________No________ If not, explain:_____________________________________________ 23. Please list the property received by check writer from you: _________________________________ 24. Has the party made or offered to make full or partial restitution on the check? Yes_______No__________ If yes, explain, including dates and manner of contact or payment:______________________________ ____________________________________________________________ 25. Have you had any conversation with the maker or passer about this particular check? Please explain, including dates and whether by phone or in person. (Please attach on separate sheet of paper). 26. I understand that no prosecution will be undertaken where I have received full or partial restitution for the check: that no restitution will be accepted by me or by my business as to this check outside of court proceedings once this prosecution is commenced; that this is a request for prosecution of a criminal violation; that the prosector's office is not a debt collection agency; that if the check writer is ever eventually located and brought to court, the penalty to be imposed is in the discretion of the court and may or may not include a requirement of restitution; that the decision as to whether to pursue any writer of a worthless check is a discretionary decision to be made by the prosecutor and that it may be difficult or impossible to locate a check writer or to bring the writer back to this jurisdiction if the writer is found in some distant location. ____________________ Dated ___________________________________________________ Your signature --------------------------------------------------------------------- FORM 4. page 3 of 3 Revised 5/22/97 --------------------------------------------------------------------- Affidavit for Restitution M.S.611A.04 State of Minnesota District Cotirt COUNTY of BECKER JUDICIAL DISTRICT CASE NO. SEVENTH AFFIDAVIT FOR RESTITUTION State of Minnesota, Plaintiff VS. ____________________ Defendant ________________________________________________, being duly sworn, states that the following property was damaged, stolen or destroyed by__________________________________________, defendant, and that the total value of such property, if stolen or destroyed, is $_______________________________, and if damaged is $_________________________________. The following is a list of the value and/or damage of each of the following described property items. (List below and attach estimates or receipts. Attach another sheet if necessary.) Amount of check______________________ $______________________ BANK FEES AND POSTAGE $ 20.00__________________ TOTAL $______________________ My losses/damages (were) (were not) covered by insurance. Name of insurance company____________________________________________ Policy No.____________________________________ Deductible/uninsured loss:______________________________ Name and address:____________________________________________________ Signed and sworn to before me on ____________________________________ _____________________,19______. Signature __________________ Deputy/Notary Public NOTE: This affidavit for restitution must be completed and returned to the court administrator not later than_____________, 19 If the affidavit is not received by this date, it will be assumed you do not wish to claim any restitution in this matter. Failure to claim restitution will not result in the loss of the right to pursue any other civil remedy available by law. Page 1 of 1 Approved by Conference of Chief Judges 04/20/90 Revised: IIIIEI/94 5-1 3