Stop payment

1234, Main Street
Boston, MA 02123

05 April, 2005

<Recipient Address Goes Here>

Hello,

You are hereby requested to refuse payment upon presentation of the following check or draft on my account number <Account Number>:

Check Number: <Check Number>

Check Date: <Check Date>

Amount: <$Check Amount>

Payee: <Name of Payee>

If this check has already cleared, please let me know immediately.

Regards,

Robert Anderson

encl: <List of enclosed items goes here>

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