COLLECTION DISPUTE FORM
Criminal Division
WWW.LEECLERK.ORG 1700 Monroe Street, Fort Myers, Florida 33901│239-533-5000
Rev. 08/29/2008
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.