This form is used by the local Treasurer to report Estimated Payment Bad Checks to Virginia Tax. The local Treasurer's Office is responsible for handling bad checks submitted by customers; however, for those customers who do not redeem the bad check within the specified time (5 days), the Local Treasurer's Office must submit the Estimated Bad Checks Report to Virginia Tax by fax or mail.

Instructions

Complete the fields of the form for each bad check according to the instructions on the form.

1. Make a copy of the front and back of each reported bad check.
2. Mail or fax to 804.367.3014 the check copies and the form to Virginia Tax as instructed on the form.