"We have cause to believe that on (date) you, or your minor child (child's name), committed retail fraud in the first, second, or third degree by (description of action and property involved) in our store or in its immediate vicinity.
State law authorizes us to demand in writing that you do all of the following, as applicable:
[ ] Return the property in salable condition or pay to us $ ______, which represents the full retail price or the remaining balance of the full retail price of the property.
[ ] Pay to us $ ______, which represents the full retail price of the recovered property that is not in salable condition.
[ ] Pay to us civil damages in an amount equal to 10 times the retail price of the property involved, but not less than $50.00 or more than $200.00, equaling a total amount of $ ______.
This notice is a formal demand for return of the property involved, if applicable, and the payment of the amounts indicated above, equaling a total amount of $ ______. If you return any unrecovered property and pay the amounts indicated above to us within 30 days after the date this notice was mailed, we will not take any further civil action against you.
You are not required to respond to this demand if you believe that you or your minor child are not guilty of committing retail fraud or if you choose not to respond. If you fail to comply with this demand, we will be authorized by state law to bring a civil action against you to determine your legal responsibility for the return of any unrecovered property and the payment of the amounts indicated above plus the cost of the action, including reasonable attorney fees.
These civil proceedings do not prevent criminal prosecution for the alleged act of retail fraud.".
MCL 600.2953