Pictured is a completed Form 8290, Returned Check Repayment Notice. This form is prepared and attached to the dishonored check to indicate why the check is being returned. Reasons for Returned Check is bank closure, uncollected funds, mutilated check, and other. The form states Your check was returned unpaid for the reason shown below. Because this was not within your control, you were not charged a penalty for the returned check. If you pay this amount in full within 10 days from the date of this notice, your payment will be processed with the same date as your original payment. This example shows that the check is being returned because it is a mutilated check.