Outstanding Checks Application Letter Form

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Date
Name
Address
Address
To Whom It May Concern,
In an attempt to clear up outstanding items, we found that check # ______ was issued to
you on _______ in the amount of $_______ for _____ and has not cleared our bank to
date. Please inform us on your preference:
____ Please void the check and consider it a donation to _______.
____ Please reissue a replacement check to me.
____ I still have the check and will cash it (if less than 12 months old).
____ Other:___________________________________________
Please reply within 10 business days. If we do not receive a response from you, we are
obligated by law to turn the money over to the State of California.
Sincerely,

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