To:                                                                                            Date:________________

From:

Dear:____________________________

On __________________ you issued check(s) number(s) _____  _____  _____   _____

for the amount of _____ _____ _____ _____ from the __________ Bank in consideration of cash and/or merchandise.

On _________________ the check was returned to me by the bank marked _________________________.

The purpose of this letter is to advice you that unless restitution is made within eight (8) days, a warrant will be obtained for your arrest on charges of "ISSUING A BAD CHECK", Connecticut Penal Code 53a-128.

_____________________________________

(complainant’s signature)

_____________________________________

(name of business)

 _____________________________________

(address)

 ____________________________________

(city, state, zip code)