Superior Court of California County of San Francisco CCP §1719 provides that any person who passes a check that is returned for non-sufficient funds ("NSF") or because the maker has no account or stops payment on a check without proper justification, and who fails to pay the amount of the check plus service charges and mailing costs, in cash, to the payee within thirty (30) days following a written demand sent to the maker by certified mail, can be sued for statutory damages by the check's payee. CASE #____________ Original check(s)..................................................................................................... Yes If not, Declaration and Order re: unavailability of original......................................Yes No No CHECKLIST FOR COURT JUDGMENT CONTRACT - BAD CHECK Bank dishonored check for (a) Insufficient funds................................................Yes No **(b) Stop payment ......................................................Yes No (If "stop payment", then convert to Court Judgment; 585 Declaration for Judges review)Yes No Copy of Demand letter .............................................................................................Yes No Signed certified mail receipt submitted.....................................................................Yes No Complaint filed no sooner than 30 days from date of mailing.................................Yes No Does Demand letter include a warning that, in addition to the amount of the check, defendant is liable for damages of at least $100. If higher, 3x the amount of the check ­up to $1500, plus mail costs...............................................................................................................................Yes No Demand letter demands that defendant pay exact amount of check only ( no added bounced check fee)..................................................................................................................................Yes No For Court Use Only Date: ______________ Clerk: _________________ Page 1 of 2 CK-1 American LegalNet, Inc. www.FormsWorkFlow.com CHECKLIST FOR COURT JUDGMENT- CONTRACT- BAD CHECK Case # _____________ continued Treble damages requested (cannot exceed $500.00 for each check)..................Yes No Amount awarded.........................................................................................................$______________ Prejudgment interest requested (10% if after 1986)...........................................$______________ (_________% X ________days-due to Judgment) Check #_______ signed:_______________________ Dishonored_______________ TOTAL PRE-JUDGMENT INTEREST AWARDED...................................................$_______________ CHECKLIST FOR COURT JUDGMENT- CONTRACT- BAD CHECK Page 2 of 2 CK-1 American LegalNet, Inc. www.FormsWorkFlow.com