Ldentity Theft Victim'S Complaint And Affidavit (Page 5 of 8) in pdf

Ldentity Theft Victim'S Complaint And Affidavit Page 5

Victim's Nome

Phone number (_)

(20)

One way to get a credit reporting agency to quickly blocl< identity theft-

related information from appearing on your credit report is to submit a

detailed law enforcement report ("ldentity Theft Report"). You can obtain

an ldentity Theft Report by taking this form to your local law enforcement

office, along with your supporting documentation. Ask an officer to witness

your signature and complete the rest of the information in this section. lt's

important to $et your report number, whether or nor you are able to file in

person or $et a copy of the official law enforcement report. Attach a copy of

any confirmation letter or official law enforcement report you receive when

sending this form to credit reporting agencies.

Select ONE:

[ | have not filed a law enforcement report.

D I was unable to file any law enforcement report.

n I filed an automated report with the raw enforcement agency listed

below.

tr | filed my report in person with the law enforcement

officer and agency listed below.

Poge 5

(20):

Check

have

not..." if you have

not yet filed a

report vith law

enforcement or

you have chosen

not to. Check "l

was unable..." if

you tried to file

a report but law

enforcement

refused to take it.

Automated report:

A l a w

enforcement

report tiled

through an

automated

system, for

example, by

telephone, mail,

orthe lnternet,

instead of a

face-to-face

interview with a

law enforcement

officer.

Law Enforcement Department

Report Number

Filing Date (mmlddlyyyy)

Officer's Name (please print)

Officer's Signature

(_)

Badge Number

P h o n e N u m b e r

Did the victim receive a copy of the repoft from the law enforcement officer?

r i . 5

Victim's FTC complaint number (if available):

E Y e s O R X N o

Ldentity Theft Victim'S Complaint And Affidavit Page 5

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