APPLICATION
RET('~ED CHECK NOTIFlr TI
?4eR ill
DEPARTMENT: c.f"1d/"A/n_ If' "'(j DATE:
Please complete the foUowing and return a copy to Finance. Inform
there are any changes to this information. Arrange for the check to be repl r cbeck
or cash at the Finance Department office on the second floor of City Hall. There is a $20.00
cbarge which must be paid at the same time. Checks are to be made to the City ofboynton Beach
and it is advisable to bring the correct change when paying in cash.
It is up to the Department where the check was issued. to make initial contact with the
person who wrote the check. in order to establish the time as to when repayment win be made. If
the matter is DOt resolved as agreed, Finance wiU make any additional CODtacts nec-essary until
the check has been made good. However, resolving the problem on a timely basis, depends on
complete and correct information below. We will keep you infonned as to when the matter is
settled.
ENDORSER'S NAME:
PHONE:
ADDRESS:
REASON FOR CHECK:
DA TE OF CONTACT (METHOD):
COMMENTS:
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