Phoenix Police Department'S Identity Theft Victim'S Packet Page 7
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13Name ______________________ Phoenix Police Department Report Number __________________________Page 3
Victim’s Law Enforcement Actions
17. (check only one)
I am willing to assist in the prosecution of the person(s) who committed this fraud.
I am NOT willing to assist in the prosecution of the person(s) who committed this fraud.
18. (check only one)
I am authorizing the release of this information to law enforcement for the purposes of assisting
them in the investigation and prosecution of the person(s) who committed this fraud.
I am NOT authorizing the release of this information to law enforcement for the purposes of
assisting them in the investigation and prosecution of the person(s) who committed this fraud.
19. (check all that apply) I
have
have not reported the events described in this affidavit to the police
or other law enforcement agency. The police
did
did not write a report. In the event you have
contacted the police or other law enforcement agency please complete the following information:
______________________________________
_________________________________________
(Agency #1)
(Officer/Agency personnel taking report)
______________________________________
_________________________________________
(Date of Report)
(Report number, if any)
______________________________________
__________________________________________
(Phone number)
(email address, if any)
______________________________________
_________________________________________
(Agency #2)
(Officer/Agency personnel taking report)
______________________________________
_________________________________________
(Date of Report)
(Report number, if any)
______________________________________
__________________________________________
(Phone number)
(email address, if any)
Documentation Checklist
Please indicate the supporting documentation you are able to provide to the companies you plan notify.
Attach copies (NOT originals) to the affidavit before sending it to the companies.
20.
A copy of a valid government-issued photo-identification card (for example, your driver's license,
state-issued ID card, or your passport.) If you are under 16 and don't have a photo-ID, you may
submit a copy of your birth certificate or a copy of your official school records showing your
enrollment and place of residence.
21.
Proof of residency during the time the disputed bill occurred, the loan was made or the other event took
place (for example, a rental/lease agreement in your name, a copy of a utility bill or a copy of an
insurance bill.
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