"You are hereby notified that the following instrument(s)
Number | Date | Amount | Name of Bank | |
__________________ | __________________ | __________________ | __________________ | |
__________________ | __________________ | __________________ | __________________ | |
__________________ | __________________ | __________________ | __________________ | |
__________________ | __________________ | __________________ | __________________ | |
__________________ | __________________ | __________________ | __________________ |
drawn upon __________________ and payable to __________________, (has) (have) been dishonored. Pursuant to Georgia law, you have ten days from receipt of this notice to tender payment of the total amount of the instrument(s) plus the applicable service charge(s) of $__________________ and any fee charged to the holder of the instrument(s) by a bank or financial institution as a result of the instrument(s) not being honored, the total amount due being __________________ dollars and __________________ cents. Unless this amount is paid in full within the specified time above, a presumption in law arises that you delivered the instrument(s) with the intent to defraud and the dishonored instrument(s) and all other available information relating to this incident may be submitted to the magistrate for the issuance of a criminal warrant or citation or to the district attorney or solicitor-general for criminal prosecution."; or
OCGA § 16-9-20