Id Theft Affidavit (Page 6 of 7) in pdf

Id Theft Affidavit Page 6

ID THEFT AFFIDAVIT

Victim Signature

I declare under penalty of perjury that the information I have provided in this affidavit is true and correct to

the best of my knowledge.

___________________________________________________________________

_____________________________

Signature

Date Signed

___________________________________________________________________

Print Name

Knowingly submitting false information on this form could subject you to criminal prosecution for perjury.

Witness Signature

Please have one witness (non-relative) sign below that you completed and signed this affidavit.

Witness:

___________________________________________________________________

_____________________________

Signature

Date Signed

___________________________________________________________________

Print Name

Please complete and return pages 1 through 5 of this form with copies of

appropriate documentation to:

Pacific Gas and Electric Company

Fraud Department

P.O. Box 8329

Stockton, CA 95208

Page 5 of 6

Id Theft Affidavit Page 6