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. Pursuant to Iowa law, you have 10 days from receipt of this notice to tender payment of the full amount of
such check plus a service charge not to exceed $30, the total amount due being $____ .
Unless this amount is paid in full within the time specified above, the holder of such check may turn over the dishonored check and all other available
information relating to this incident to the Dubuque County Attorney for criminal prosecution.

 

Closing,
Your name/address