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Pay More Drug Store
Mr. and Mrs. Robert Doe Dear _____________ This store has a report showing that on __________, your child took from us ___________________without permission, without paying for them, and to use them as his/her own. State law provides that we can demand that you pay these penalties: The selling price of the stolen items $__________ (Even if we have recovered the item) A penalty of no less than $100 and no more than $200 $__________ TOTAL AMOUNT DEMANDED $__________ This letter is our demand. The parent or legal guardian of a child is responsible for payment of this demand. A copy of the state law allowing demand is attached. Please send your check or money order to ___________________________________ If you do not pay by __________, we will take this demand to civil court. This demand is made by this store. It is separate f from any criminal prosecution by the city or county. This demand does not take the place of fines or punishment, which may be handed out by the criminal court. If you disagree with this demand you may wish to contact Richard Nelson, Store Manager at (509) 488-5724. You may also wish to talk to a private attorney. If you do not pay this demand, we will file a court action. You will then have the chance to defend your position in civil court. (Signed by store owner or manager) Note: This form may be used to authorize a store employee, other than the manager or owner, to represent the business. However, claims cannot be assigned to a collection agency or other third party.
Shoplifting Report Store________________________________Date_______________________________ Address_________________________ Time statement started ______am/pm This statement is made voluntarily of my own free will; no one has threatened or in any way enticed me with any promises to make it. ___________________________
Signature of Person Making Statement I, (suspect’s name) do reside at (address). While in the above-named store on (date), I was stopped inside/outside the store by (name of employee, owner, manager, or security officer) who did identify himself/herself first While in the above-named store on (date) at or about _____am/pm, I did appropriate to my own use the item(s) listed below without first paying for or Quantity Item Value
I fully understand this statement and realize that it may be used against me in a court of law.
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(Signature of Person Giving Statement) Witnesses: ______________________ _______________________________ (Signature) (Signature) Time Statement Finished: _______am/pm Date:__________________ Race_____ DOB____________ Ht._____________ Comp.________ Eyes___________ Sex___ Build_______ Wt._____ Hair________ Scare/Marks______________________ Occupation________________ Employer________________ Spouse_______________
Vehicle Used Make Model Color Body Style License Number School Attends_________ Juvenile Yes/No Grade_____ Parents/Guardins____________ Address_____________________ Phone____________ Notified By Whom__________ How Notified_____________ Date/Time____________ |