Fillable Form 62704: RECLAMACIN DE INVESTIGACIN PARA CHEQUE FALSIFICADO (Illinois State Treasurer's Office)

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Form 62704: RECLAMACIN DE INVESTIGACIN PARA CHEQUE FALSIFICADO (Illinois State Treasurer's Office)

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Illinois State Treasurer’s Office
Attn: Warrant Division/Forgery
Section
400 West Monroe Street, Suite 401
Springfield, IL
62704
Phone: (217)
782-4117
Fax: (217)
558-4028
RECLAMACIÓN DE INVESTIGACIÓN
PARA CHEQUE FALSIFICADO
1. Nombre del Reclamante: ____________________________________________________
2. Dirección del Reclamante: ____________________________________________________
3. Números de Teléfono
del Reclamante: (casa) ____________________ (trabajo) _____________________
4. Agencia del Estado de Illinois
que proporcionó el cheque(s): ________________________________________________
5. ¿Los fondos del cheque(s) verdaderamente le pertenece a usted? Sí _____ No _____
6. Favor imprimir información detallada para explicar cómo se descubrió la falsificación del
cheque(s) que occurió en su nombre. (Favor de usar papel adicional si es necesario.)
01/11
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Form 62704: RECLAMACIN DE INVESTIGACIN PARA CHEQUE FALSIFICADO (Illinois State Treasurer's Office)

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Completed 20 July 2020

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