Date

Dear Check Writer:

This is to inform you that I am in receipt of a check alleged to have been written by you dated _______, made payable to __________, drawn on __________ bank in the amount of $ ________. This check was presented to me in the usual course of business and was returned to me from the above stated bank marked (insufficient funds or account closed).

In accordance with the Michigan statute you are hereby given 5 days notice that said check has not been paid, and if you shall not have paid the amount due thereon within 5 days of receipt of this notice, this shall serve as evidence of intent to defraud, and a request to the Prosecuting Attorney's Office for Oakland County, to take a criminal action will be made by me.

Signed,

Your name
Address