Notice Of Identity Theft - Affidavit Of Fact printable pdf download

Notice Of Identity Theft - Affidavit Of Fact

Notice of Identity Theft - Affidavit of Fact:

Sent credit report request via (include all that apply):

□

e-mail

fax

mail (certified return receipt requested no.) ____________________

To (Name of company): ___________________________________________________

Investigator: ____________________________________________________________

Address:_______________________________________________________________

Other contact info: _______________________________________________________

Today’s Date: __________________________________________________________

I have become aware that ______________________________________ (deceased’s name)

has become a victim of identity theft.

Person reporting the fraud: (documentation of relationship attached, if appropriate)

My Name:______________________________________________________________

Address (city/state/zip): ___________________________________________________

Phone Number (daytime/evening/cell)________________________________________

Email address: __________________________________________________________

Relationship to Deceased: _________________________________________________

As the _________________

, I am notifying you that the following

(relationship to deceased)

person died and that they appear to have been a victim of identity theft, financial fraud or false

personation.

Information about the deceased: (copy of death certificate attached)

•

Full legal name of deceased: __________________________________

•

Date and time of death: _______________________________________

•

Date of birth:________________________________________________

•

Location of birth:_____________________________________________

•

Social Security number of deceased:_____________________________

•

Five year address history

(most current one first): ______________________

_______________________________________________________________

ITRC Letter Form 117-2

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Notice Of Identity Theft - Affidavit Of Fact