Misidentification Victim Worksheet (Page 3 of 4) in pdf

Misidentification Victim Worksheet Page 3

Misidentification Victim

Worksheet

Please complete all of the following form. If you do not have information available

to answer a particular question, please so indicate in the form.

Eligibility to Seek Expunction

Did another person falsely use your name, address, date of birth, driver's license

number, and/or social security number as his or her own identifying information

when that person was arrested for a felony or misdemeanor?

YES / NO

Is there any other reason why your name, address, date of birth, driver's license

number, and/or social security number are contained in the arrest records or files

of the person arrested?

YES/ NO

If YES, please explain: __________________________________

_________________________________________________________________

Did you consent to the false use of your name, address, date of birth, driver's

license and/or social security number by the arrested person?

YES/ NO

II.

Details of Misidentification

Please explain in detail the circumstances of the theft of your identity. Please include any

relationship (e.g., familial, acquaintance, employment) between yourself and the arrested

individual. Please explain, if you know, how your identity was stolen, and how you

discovered the theft of your identity. Please include all other instances in which your

identity was misused by this person. More detail is better than less. Please attach

additional pages if necessary.

________________________________________________________________________

Misidentification Victim Worksheet Page 3