TETON COUNTY, WYOMING

NON-SUFFICIENT FUNDS/ACCOUNT CLOSED CHECKS

 

INSTRUCTIONS

(please follow carefully)

 

  1. The entire report enclosed must be completed legibly for each check submitted.  Please print or type.

 

  1. The report must be signed by a person in a position of authority; i.e. manager, owner, etc., or the payee named on the check.

 

  1. Unlike suing in civil court, be aware that you or your business may never receive restitution as a result of criminal prosecution.  Furthermore, unlike suing in civil court, a successful prosecution  can result only if it can be shown that the check passer intended to defraud you.  If this is not true, you can still pursue your case civilly.

 

  1. A five-day statutory demand notice must be sent to the passer in each check case.  This notification should be sent by certified mail, return receipt requested, and you should retain a copy of the notice letter sent along with proof that the letter was received by the issuer of the check, Use one notice for each check.  In addition, you should attempt to make personal “face to face” contact with the passer concerning the check and document your efforts.  If  you are not successful in obtaining a return receipt, the Sheriff’s Department will attempt to serve the notice.  This service will be charged at the Sheriff’s current rate for paper service.

 

  1. Submit with this report:

A)     A copy of the check, front and back.  Make arrangements to present the original when reported.

B)     A copy of the five-day notice you sent.

C)    The Post Office return receipt showing it’s delivery or a Sheriff’s return showing service of the notice.

Do not submit a report and this check for possible prosecution unless you are satisfied that the passer intended to defraud you and you are willing to participate in prosecution even if the passer attempted to pay for the check at a future date.

 

  1. Checks are accepted for prosecution only and are not returned if civil proceedings are initiated.

 

  1. Certain types of checks will normally not be accepted for prosecution.  These include:

A)     Checks dated more than 60 days prior to the date this report is submitted to law enforcement.  (Complete Part III only)

 

B)     Post-dated checks or checks which you agree to hold before depositing.

 

C)    Checks that have been turned over to a collection agency, unless the collection agency refers the check to law enforcement within fourteen (14) days of receipt.

 

D)    Checks that you have accepted full or partial payment on.

 

E)     Two-party checks.

 

  1. Please return the report and required documents to the appropriate law enforcement agency:
  2. For checks received in the town of Jackson, or Teton County:

 

Teton County Sheriff’s Office

Attention: Investigations 180 S. Willow

P.O. Box 1885

Jackson, WY  83001

(copy as needed)

 

Date Received:____________________                              Case #_________________________

 

NSF __________        Acct Closed____________      Other___________________________

 

Name(s) on the account:__________________________________________________________

 

Law Enforcement Use Only - Make No Marks Above This Line

____________________________________________________________________________________

_________________________________________________________________________________

 

REPORT

 

Part I

 

To be completed by person making this report.

 

The following report should be completed for each check submitted to the Sheriff’s Department.  Please make a reasonable effort to fully complete the form.  If the answer to a question is not known, write “unknown”.

 

1.        Business name:______________________________________________________________

           Business address:____________________________________________________________

           Business phone:_____________________________________________________________

 

2.        Person making report:______________________________________  Title:______________

           Home address:______________________________________________________________

           Home phone:________________________________________________________________

 

3.        Full name and address of business, branch or place where check was accepted:

           ___________________________________________________________________________

4.        Check number:_______  Date check was accepted:_________________  Amount:________

 

5.        Name of person who presented the check:________________________________________

 

6.        Please detail what steps you or your employees have taken to contact the passer and/or recover your loss:

           Was the passer contacted? ____________________________________________________

           By whom and when? _________________________________________________________

           Where? ____________________________________________________________________

 

7.        Has the passer attempted to make restitution?  If so, please detail the circumstances.

           ___________________________________________________________________________

           ___________________________________________________________________________

           ___________________________________________________________________________

 

8.        Have you successfully served a five-day statutory demand notice on the passer?  Yes/No

           If so, how?__________________________________________________________________

           Certified Mail/Sheriff’s Service/Personal Service/Other:______________________________

           If not served, why?___________________________________________________________

 

9.        Do you feel you have exhausted your ability to collect this check?  Yes/No

 

10.       Do you feel that the passer of the check intended to defraud you when he/she passed the checks?  Yes/No

 

11.       Have you retained an attorney or turned this matter over to a collection agency in an attempt to collect this check?  Yes/No

           If so, whom?________________________________________________________________

 

12.       Please note any information you feel would help in locating & prosecuting this person.

 

The decision whether or not to prosecute this individual will be made by a representative of the Teton County Attorney’s Office who will take into account numerous factors including: what evidence exists showing intent to defraud, the availability of necessary bank records, etc..  Criminal prosecution does not guarantee restitution since prosecution is designed to punish the criminal offender, not to collect debts.  If you agree to prosecute this individual, you can not drop the charge if he/she offers to pay off the check.  If a violation of criminal law can not be proven, the check will be returned to you upon request.

 

I hereby understand and agree that all the information contained in this report may be used by and disseminated among all Law Enforcement Agencies, the Office of the County Attorney and the Courts.  I also understand and agree that this check is being submitted for criminal prosecution and that if criminal prosecution is initiated, it may be necessary for those persons having knowledge of the facts to appear and testify in court.

 

I hereby certify that no one has accepted full or partial restitution for this particular check as of this date and I further agree not to accept restitution without obtaining the consent of the County Attorney’s Office.

 

I hereby certify that I have read and understand the instructions for this report and that all of the facts  contained herein are to the best of my knowledge, true, accurate and complete.

 

 

 

 

Signature of person making report:_____________________________________________________

 

Date:_____________________________________________________________________________

 

 

 

 

Part II

To be completed by the person who actually took the check.

 

1.           Name:________________________________________________________________________________

2.           Address:______________________________________________________________________________

 

About the passer:

3.           Description:  Race:_______   Sex:______   Age:______   Ht:______   Wt:______             

              Hair Color:____________________ Hair Length:________________________________________

4.           Name given:___________________________________________________________________________

5.           Address given:_________________________________________________________________________

6.           Phone number given:____________________________________________________________________

7.           Claimed employment at:__________________________________________________________________

8.           Driver’s license number:___________________________________________   State:_________________

9.           Did photo on driver’s license match the passer:________________________________________________

10.         Other ID and number:____________________________________________________________________

11.         Description of vehicle involved (if any):  Make:________________________________________________

              Model:___________________________________      Color:______________________________________

              License plate number:_____________________________       State:_______________________________

12.         Names (if known) and descriptions of any persons who accompanied the passer:

              _____________________________________________________________________________________              _____________________________________________________________________________________

              _____________________________________________________________________________________

13.         Names of other persons who witnessed the transaction and their phone numbers:

              _____________________________________________________________________________________
              _____________________________________________________________________________________

              _____________________________________________________________________________________

14.         Do you recall the transaction?_____________________________________________________________

15.         Was the passer known to you?_____________           If yes, how?________________________________

              _____________________________________________________________________________________

16.         As the person who accepted the check, can you identify the passer?_______________________________

              If yes, how?____________________________________________________________________________

17.         What did the passer receive in exchange for the check?

              Cash (amount):_________               Services (value):__________          Credit (value):_________________

              Merchandise (description & value):_________________________________________________________

              _____________________________________________________________________________________

              Other (explain):_________________________________________________________________________

              _____________________________________________________________________________________

18.         Was the check post dated?_______________________________________________________________

              Did the passer ask you to hold the check to a future date?_______________________________________

              Did the passer ask you not to deposit the check until a future date?________________________________

              Did the passer indicate there might not have been enough money in the bank to cover the amount of the

check?___________________________________________________________________________

              If yes to any of the above, what did the passer say?____________________________________________

              _____________________________________________________________________________________

              _____________________________________________________________________________________

              _____________________________________________________________________________________

19.         Did you see the passer write out the entire check and endorse it?_________________________________

20.             Was the check either entirely or partially pre-written?_________________________

 If yes, what part was pre-written and what part did you see the passer write?_________________

           _____________________________________________________________________________

           _____________________________________________________________________________

21.       Did you initial, mark upon, or write upon the check at the time you accepted it?______________

           If yes,what?___________________________________________________________________

           _____________________________________________________________________________

 

I hereby certify that all of the facts contained herein are to the best of my knowledge, true, accurate and complete.

 

Signature of person who accepted the check:________________________________________________

Date:_________________________________________________

 

 

Part III

 

To be completed by person making the report.

 

 

This portion of the report should only be completed for each check received which has been dated more  than 60 days prior to the date this report is submitted to law enforcement.  Part I and II need not be submitted for checks over 60 days old unless requested by law enforcement agency or County Attorney’s Office.

 

 

The information provided in this part will be used for police and court purposes, i.e. sentencing, screening, Department of Probation & Parole, etc..  The information may not result in prosecution.

 

1.        Business name:_______________________________________________________________

 

           Business address:______________________________________________________________

 

           Business phone:________________________________________________________________

 

2.        Person making report:________________________________          Title:_____________________

 

           Home address:_________________________________________________________________

 

           Home phone:__________________________________________________________________

 

3.        Full name and address of business, branch or place where check was accepted:

 

           _____________________________________________________________________________

 

4.        Name(s), address, phone, etc. For the account as imprinted or written on the check:

 

           _____________________________________________________________________________

 

           _____________________________________________________________________________

 

5.        Name of bank:______________________________________          Account #:_________________

 

6.        Check number:_____________                     Check dated:____________    Amount:____________

 

7.        Date check was accepted:________________________________________________________

 

8.        Name of person who presented the check:___________________________________________

9.        Name endorsed on the signature line:_______________________________________________

 

 

 

DO NOT SUBMIT CHECK IF COMPLETING PART III ONLY

 

 

 

 

 

 

(copy as needed)

 

FIVE-DAY STATUTORY DEMAND NOTICE

 

 

 

To:       ____________________________________________                    Date:__________________

           ____________________________________________

           ____________________________________________

 

This letter is to advise you and give you notice of a nonpayment and dishonor of a check written by you.  Said check is described more fully below.  This check was returned by your bank to the payee with “____________________________________________” stamped or noted on the face of the check.

 

 

           *                    *                    *                    *                    *                    *         

 

Check number:________________     Date:____________________ Amount:________________

 

Pay to:__________________________________________  Signed:__________________________

 

Bank:____________________________________________________________________________

 

           *                    *                    *                    *          `          *                    *

 

 

You are further notified that Wyoming Statute Section 6-3-703 provides:

(A)       Any of the following is Prima Facie evidence that the person at the time he/she issued the check or other order for payment of money intended that  it should not be paid:

 

           (I)        Proof that at the time of issuance he/she did not have an account with the drawee;

(ii)               Proof that at the time of issuance he/she did not have sufficient funds with the drawee and that he/she failed to pay the

check or other order within five (5) days after receiving notice of nonpayment or dishonor, personally given or sent to the address shown on the check or other order; or

(iii)             Proof that when presentment was made in a reasonable time the issuer did not have sufficient funds with the draw and

 he/she failed to pay the check or other order within five (5) days after receiving notice of nonpayment or dishonor, personally given or sent to the address shown on the check or other order.

(B)       Proof that the drawer opened an account with the draw on a certain date shall be considered evidence of the drawer’s knowledge of the account balance on that date.

 

You are also notified that if you do not pay the above described check within five (5) days of receiving this notice, excluding the date of receipt, this matter will be referred to the Teton County Attorney’s Office for prosecution.  Restitution must be made to the person or organization listed below.

 

Sincerely,

 

 

________________________________________________________

 

 

Name:___________________________________________________

Address:_________________________________________________

Phone:___________________________________________________