Date
Dear Check Writer:
You are hereby notified that a check number ______ in the face amount of $________, issued by you on _______________ drawn upon ____________ bank, and payable to ____________________, has been dishonored. You have 10 days from the receipt of this notice to tender payment of the full amount of such check plus a service charge of $35.
Unless this amount is paid in full within the time specified above, the holder of such check may turn over this dishonored check and all other available information relating to this incident to the State's Attorney's Office for potential criminal prosecution.
Closing,
Your name / Address