"DEMAND FOR PAYMENT OF DISHONORED CHECK, DRAFT, ORDER, OR OTHER INSTRUMENT FOR THE PAYMENT OF MONEY
Notice: You may be sued 30 days after this notice if you don't make payment within 30 days of this notice
DATE:
TO: Name of Drawer
Last known residence address
or place of business
YOUR CHECK, DRAFT, ORDER, OR OTHER INSTRUMENT FOR THE PAYMENT OF MONEY IN THE AMOUNT OF $ ____ , DATED ________ , PAYABLE TO THE ORDER OF ____________ HAS BEEN DISHONORED BY THE BANK/DEPOSITORY UPON WHICH IT WAS DRAWN, BECAUSE:
( ) YOU HAD NO ACCOUNT WITH THAT BANK/DEPOSITORY
( ) YOU HAD INSUFFICIENT FUNDS OR CREDIT WITH THAT BANK/DEPOSITORY
( ) A STOP PAYMENT ORDER WAS ISSUED
( ) OTHER (specify)
IF YOU DO NOT MAKE PAYMENT, YOU COULD BE SUED UNDER SECTION ____ OF THE DISTRICT OF COLUMBIA OFFICIAL CODE TO RECOVER PAYMENT. IF JUDGMENT IS RENDERED AGAINST YOU IN COURT, IT MAY ALSO INCLUDE NOT ONLY THE ORIGINAL FACE AMOUNT OF THE CHECK, BUT ALSO ADDITIONAL DAMAGES, AS FOLLOWS:
NAME OF PAYEE:
(PHONE NUMBER)
ADDRESS TO WHICH PAYMENT SHOULD BE DELIVERED
IF YOU DISPUTE ANY OF THE FACTS LISTED ABOVE, CONTACT THE PAYEE IMMEDIATELY.".
D.C. Code § 28-3152