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Complete an Application for Statement of Charges for Bad Check (form DC-CR-044). Complete an Application for Statement of Charges for Bad Check (DC-CR 044).You may use this sample "bad check" demand letter if someone wrote you a check but had insufficient funds to cover it. If we cannot accept your case, then contact your local Justice of the Peace to file Issuance of a Bad Check charge or a civil suit. Depending on the particular check, you will be asked to fill out an application for either an arrest warrant or a citation. The report must be notarized. Generally, the bank will require you to complete an affidavit stating that you did not authorize the check. As a public service, the staff of the Federal Trade Commission (FTC) has prepared the following complete text of the Fair Debt Collection Practices Act. You should review your deposit account agreement for any applicable language. Can I get my cancelled checks with my bank statement?