1234, Main Street
Boston, MA 02123
06 April, 2005
<Recipient Address Goes Here>
Re: <insert case name>
Small Claims case No. <case number>
Please find enclosed a check numbered <check number> made payable to <name of payee> in the amount of <$ amount>. This check represents full and final settlement of the small claims judgment entered on <insert date judgment was entered>. The negotiation of this instrument will terminate any further obligation on my part in this matter.
encl: <List of enclosed items goes here>