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Rule Title: FORMS
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Department: JUSTICE, DEPARTMENT OF
Chapter: PROCEDURAL RULES
Subchapter: Referral of Debt for Recovery and Offset
 
Latest version of the adopted rule presented in Administrative Rules of Montana (ARM):

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23.2.404    FORMS

(1) The department shall refer a debt to the department of administration, or other agency designated by law, on the attached form.

BAD DEBT CERTIFICATION & TRANSFER FORM

 

Agency Name:

 

(Department Use Only)

 

Document Locator No.

 

<

 

Instructions:   Prepare five copies, keeping the last copy for agency file; send remaining four copies to the Department of Administration, Debt Collection Services, Mitchell Building, Helena, MT 59620. A complete file on bad debt must accompany form.   See MOM Chapter 2-1100 for necessary instructions.

 

Agency Document No.

 

<

 

No Warrant Trans. Doc. No.

 

<

 

 

 

 

DATA PROCESSING ENCODING SUMMARY

 

 

 

Agency No.

 

Accounting Entity

 

Principal Amount Due

 

Account Name

 

02

 

 

 

 

 

 

 

 

 

Interest

 

Penalties

 

Other Charges

 

Account Address

 

 

 

 

 

 

 

 

 

 

Social Security No.

 

Employer I.D. No.

 

 

 

 

 

 

 

 

 

HISTORY OF COLLECTION

 

ORIGINAL TRANSACTION

 

 

Date

 

Debt Description

 

Debt Code

 

Principal Amount Due

 

 

 

 

 

 

 

 

 

Annual Interest %

 

Interest

 

Penalties

 

Other Charges

 

Total Amount Due

 

 

 

 

 

 

 

 

 

 

 

AGENCY COLLECTION PROCEDURES

 

Date of First Notice

 

Check appropriate box:

 

G   Demand for payment was sent to debtor's last known address, but debtor cannot be contacted there;

 

G   Debtor has been offered an appropriate installment payment schedule, but Debtor has declined to agree to the schedule; or

 

G   Although Debtor agreed to an installment schedule, Debtor has not made an installment payment within ten days of the Department's demand letter providing notice of delinquency.

 

 

 

 

 

Date of Final Notice

 

 

 

 

CERTIFICATION AND TRANSFER

 

I hereby certify this to be a valid debt of the State of Montana and that every means of collection of the Account Receivable identified herein has been utilized according to agency criteria for uncollectibility.   This notice will evidence our intent to transfer this debt to the Department of Administration, Debt Collection Services.

 

Signature of Agency Official        Title              Date

 

 

 

ACCEPTANCE AND WRITE OFF AUTHORITY

 

G   Approved   We hereby accept this debt.

 

G   Not Approved   See attached material.

 

Signature of Agency Official        Title              Date

 

 

 

History: 2-4-201, MCA; IMP, 17-4-110, MCA; NEW, 1999 MAR p. 984, Eff. 5/7/99.


 

 
MAR Notices Effective From Effective To History Notes
5/7/1999 Current History: 2-4-201, MCA; IMP, 17-4-110, MCA; NEW, 1999 MAR p. 984, Eff. 5/7/99.
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