|
AFFIDAVIT
STATE
OF LOUISIANA
PARISH OF GRANT
BEFORE
ME, the undersigned authority, personally came and
appeared:
___________________________________, who did affirm and state:
That on or
about
_________________________, one ________________________________
did unlawfully
issue a worthless check in the amount of $_____________ plus______________
service
charge,
made payable to _____________________________ and gave that
check to the said
merchant/business
in payment of merchandise delivered by the said merchant/business.
Said check was later returned to the above merchant/business
stamped Insufficient
Funds
or Account Closed after being timely presented in due course.
The said
merchant/business
then duly notified ______________________________ by formal
demand
letter
to make good on the check, but the individual has failed to
reimburse the
merchant/business
for the amount owed.
WHEREFORE, affiant prays that the accused be arrested
and dealt with according to law.
______________________________
AFFIANT
THUS
DONE AND SUBSCRIBED BEFORE ME, this ________ day of ___________,
2000.
______________________________
NOTARY PUBLIC
|
