NOTICE AND DEMAND OF PAYMENT FOR MOTOR FUEL            v. 8/1/05

 

Vehicle Owner

 

Name:

 

Address:

 

City, State, Zip:

 

You are hereby notified that:

 

On, 1/1/05  your vehicle with license plate number ABC 123 was observed driving off without paying for $0.00 of Gasoline Type.

 

See Attached Sheet

See Attached Signature

                     Retail Location Employee                                                                             Approved By

 

Minnesota Statute 604.15 states:

(a)

The owner of a vehicle that receives motor fuel that was not paid for is liable to the retailer for the price of the motor fuel received and a service charge of $30.  This charge may be imposed immediately upon the mailing of this notice.

(b)

If the price of the motor fuel received is not paid within 30 days after the retailer has mailed notice, the owner is liable to the retailer for the price of the motor fuel received, the service charge as provided in paragraph (a), plus an additional civil penalty not to exceed $100 or the price of the motor fuel, whichever is greater.  The retailer shall also be entitled to interest at the rate under Minn. Stat. §549.09 from the date of nonpayment and reasonable attorney’s fees, not to exceed $500.

 

 

To avoid further costs and penalties, you must:

 

Remit $0.00 to Name of Station, Address, City, State, Zip, Phone by    2/1/05.

 

If, within the 30-day period referred to in paragraph (b) of Statute 604.15 the vehicle owner sends written notice disputing the claim that motor fuel was received without paying for it, the retailer may collect the price of the motor fuel and the civil penalties pursuant to a judgment rendered by a court of competent jurisdiction. 

 

AFFIDAVIT OF SERVICE BY MAIL

 

STATE OF MINNESOTA                            )

COUNTY OF RAMSEY                               )

                                                           

MSSA Staff, being first duly sworn, deposes and says:

That she is a citizen of the United States of America and over the age of 18 years; that on the 1st day of January, 2005, this affidavit deposited in the mailing department of the United States Post Office at 40 Arlington Avenue East St. Paul, MN 55117, Minnesota, a sealed envelope with postage thereon duly prepaid, containing a true and correct copy of the attached “Notice and Demand of Payment for Motor Fuel”.

 

That the envelope was addressed to the following person: 

 

Text Box:              

 

Signature of Person Mailing the notice
 

 


                                                                                                           

                              Text Box: Signature of Witness