Fillable CONTINUATION SHEET BAD CHECK CHARGE APPLICATION FOR STATEMENT (Maryland Courts)

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CONTINUATION SHEET BAD CHECK CHARGE APPLICATION FOR STATEMENT (Maryland Courts)

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CONTINUATION SHEET – BAD CHECK CHARGE
APPLICATION FOR STATEMENT OF CHARGES/STATEMENT OF PROBABLE CAUSE
(Criminal Law § 8-103)
MDEC counties only: If this submission contains Restricted Information (confidential by statute, rule or court order) you must
file a Notice Regarding Restricted Information Pursuant to Rule 20-201.1 (form MDJ-008) with this submission, and check the
Restricted Information box on this form.
On or about at
did unlawfully obtain
having a value of $ from
by ☐ issuing ☐ passing a certain bad check dated: Check No:
ACCOUNT NO: Drawn by:
on the:
in the sum of $ presented to:
Payable immediately to:
Above named defendant intended or believed that payment would be refused.
Said check was returned from bank marked: on
CERTIFIED MAIL SENT: RETURNED MARKED:
On or about at
did unlawfully obtain
having a value of $ from
by ☐ issuing ☐ passing a certain bad check dated: Check No:
ACCOUNT NO: Drawn by:
on the:
in the sum of $ presented to:
Payable immediately to:
Above named defendant intended or believed that payment would be refused.
Said check was returned from bank marked: on
CERTIFIED MAIL SENT: RETURNED MARKED:
DC-CR-044A (Rev. 12/2020)
DISTRICT COURT OF MARYLAND FOR
LOCATED AT (COURT ADDRESS)
DISTRICT COURT
CASE NUMBER
(City/County)
DEFENDANT’S NAME (LAST, FIRST, M.I.)
Date
Place
Property or Services
Full Legal Name of Business or Person
Full Legal Name of Business or Person
Date
Date
Date
Place
Property or Services
Full Legal Name of Business or Person
Full Legal Name of Business or Person
Date
Date
Date
Applicant’s Signature
Printed Name
TRACKING NUMBER
☐ Mark this box if this form contains Restricted Information.
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CONTINUATION SHEET BAD CHECK CHARGE APPLICATION FOR STATEMENT (Maryland Courts)

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Completed 21 April 2022

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