COLLECTION DISPUTE FORM
Criminal Division Complete this form and send with any proof of payment (such as copies of: cancelled checks – front & back, receipts, etc.) to: Lee County Clerk of Courts Traffic Office P.O. Box 2507 Fort Myers, FL 33902-2507
Name: ________________________ Address: _________________________________ _________________________________
Date of Birth: ______________ Case Number: ______________________
Amount in Dispute: $
Explanation of dispute: _____
Signature • •
Date
Upon receipt of this form, we will thoroughly research your disputed amount. Within 45 days, we will notify you by mail (at your address listed above) with the results.
WWW.LEECLERK.ORG
1700 Monroe Street, Fort Myers, Florida 33901│239-533-5000
Rev. 08/29/2008