Fourth Circuit Solicitor

William B. Rogers, Jr.
Solicitor

Check Unit Worksheet

Check Writer / Offender Information (Obtained At Time Check Was Accepted)

(Mailing Address Can Be Same As Physical Address) (Mailing City / State / Zip Can Be Same As Physical City / State / Zip)

The following section must be completed with the victim information.

Please Read

I could be held liable for the $91 in fees outlined in the S.C. Code of Laws Section 17-22-710 if I:

  • Withdraw the check from the program
  • Stop the prosecution process
  • Accept full or partial payment on this check which could result in the collection or prosecution process being stopped

By signing this form, I swear that the above is true.