Bad Check Affidavit - Hill County Attorney
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2Hill County Attorney’s Office Bad Check Program
Bad Check Affidavit
Hill County Attorney
Mail Affidavit to: Hill Co. Attorney BCP, Hill Co. Courthouse, Havre, MT 59501
After filing Affidavit, refer check writers to: 406-265-5481, ext. 211
PLEASE PRINT ALL INFORMATION IN INK & SIGN BEFORE A NOTARY ON REVERSE SIDE
To determine whether your Affidavit may be accepted as a criminal matter, answer the following questions: (Yes/No)
1. W as check post-dated at time of acceptance?___
4. W ere you asked to hold or delay depositing check?___
2. W as check received in the mail?___
5. Have you accepted any payment for this check?___
3. Does this matter involved a two-party check?___
6. Did you know there was insufficient funds when you took check?___
A “Yes” answer to any of the above questions indicates this is a CIVIL matter and is therefore ineligible for the Bad Check
Program. It should be dealt with through small claims court or turned over for private collection; do not proceed with filing an
Affidavit. If all questions were answered “No”, you may file a Bad Check Affidavit by completing the front and back side of this
form.
Check writer’s full name as written on check
1
Address(s)
City, State Zip
Home Phone #
Other Phone #
SUSPECT
SS#
Sex
Date of Birth
Hair
Eyes
Weight
Height
Driver’s License #
State Issued By:
Other ID #
Employer (if known)
Business Phone:
Staple
Documents
Business Address:
Here
How did you obtain the check writer’s identification?
Was the check handed to you by someone other than check writer? Yes No
D/L
Military ID
Name:
Other ID _________________________
Address:
Check#
Date Rec’d
Amount
What was check for?
Who can ID check writer (i.e. accepted check)?
2
Checks
List Additional
Checks on
Another Form
What did you write on the check at time you received it? D/L#
Check-Cashing Card # Your initials
Other_____________
and Attach
Has the check writer been notified? Yes
No If so, how?
Certified Mail (attach receipts) Phone
Other __________
Victim / Business Name
Phone #
3
Address
Alt. Phone #
Victim
City, State Zip
Name of Person Filing
IMPORTANT: FOLLOW REQUIREMENTS ON THE REVERSE SIDE OF THE FORM
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