There is no reasonable cause to believe that i committed the offense for which the identity thief was arrested, cited, convicted, or was the actual subject of a criminal complaint in my name. If you received a notice from the irs, return this form with a copy of the notice to the address contained in the notice if you have not received an irs notice and are selfreporting as being. Never provide bank, credit card, or other sensitive information when visiting a website that doesnt explain how your personal information would be protected, including its use. Some of the most common identity theft warning signs include. Please understand that the attorney general cannot serve as your. No, if you complete the form now, it will be sent to the irs electronically through this site. Commission ftc developed this id theft affidavit to help you report information to many companies using just one standard form. Identity theft is also defined in the code of federal regulations cfr as fraud committed or attempted using the identifying information of another person without permission. Place a 90day initial fraud alert on your credit report. Complete and submit this form if you are an actual or potential victim of identity theft and would like the franchise tax board ftb to update your account status to identify. Before you send the affidavit, contact each company to find. If i do provide my social security number, i expressly consent to the disclosure of my social security number in accordance with indiana. Follow the short information in order to complete irs ftc identity theft victims complaint and affidavit, stay away from errors and furnish it in a timely way.
Identity theft affidavit 9 free templates in pdf, word. All without detailed information about the crime, we may not be fields on this form are required. Submit this completed form and a photocopy of one of the following documents to verify your identity. Identity theft is the fastestgrowing crime in america for the very obvious reason that most of us have made our most valuable personal information name, address, social security number, drivers. Istutios fo opeti te id teft affidait do ot sed affidait to te ft o a ote oeet aey 2 if you havent already done so, report the fraud to the following organizations. The form 14039 affidavit should be filed if the taxpayer attempts to file an electronic tax return and the irs rejects it because a return bearing the taxpayers social security number already has been filed. The hidden danger of medical identity theft, as the world health organization who points out, is that this could lead to incorrect entries in the victims medical history. But there are several other types of identity theft beyond that. Name and contact information of identity theft victim full legal name first name m. Taxpayer guide to identity theft internal revenue service. Briefly describe the problem and how you were made aware of it. Data breach victims should submit a form 14039, identity theft affidavit pdf,only if your social security number has been compromised and your efiled return was rejected as a duplicate or the irs instructs you to file the form. There is no reasonable cause to believe that i committed the offense for which the identity.
Feb 02, 2020 when we hear of identity theft, or people stealing personal information to commit fraud, we may think of thieves stealing credit and bank information, otherwise known as financial identity theft. The site provides streamlined checklists and sample letters to guide you through the recovery process. When to file a form 14039, identity theft affidavit. The primary purpose of the form is to provide a method of reporting identity theft issues to the irs so that the irs may document situations where individuals are or may be victims of identity theft. Pdf identity theft is made possible by the nature of modern payment systems. Download free printable identity theft affidavit samples in pdf, word and excel formats.
Identity thefthappens when someone steals your personal informationand uses it without your permission. Someone has used my personal information to set up an account without my authorization. Tax identity theft awareness week is an annual reminder to safeguard your information when preparing taxes. Additional purposes include the use in the determination of proper tax liability and to relieve taxpayer burden. Enter your official contact and identification details. Jun 23, 2018 an identity theft affidavit is a document that can help victims of identity theft prove to a business that their personal financial data has been used to open a fraudulent account. Us legal forms, offers various forms to assist you. Ftb 3552 identity theft affidavit state of california identity theft team ms a421 franchise tax board po box 2952 sacramento ca 958122952 identity theft affidavit complete and submit this. On the website hosting the form, click start now and pass towards the editor. Previous continue about this form this form alerts the irs to your tax identity theft, so they can start resolving your case. And knowing what to do if you are a victim of identity theft starts by knowing. Please understand that the attorney general cannot serve as your private attorney, but enforces state consumer protection laws. Identity theft is one of the newest crimes occuring in the us and could get worse before things get better.
If needed, please attach additional information andor pages to this form. I consent to the release of any relevant information to the identity theft unit. Any one of the nationwide consumer reporting companies to place a fraud alert on your credit report. Identity theft affidavit pa office of attorney general. Check with the company to see if they accept this form. While many companies accept this affidavit, others require that you submit more or different forms. Omb number 154529 complete this form if you need the irs to mark an account to identify questionable activity.
Heres stepbystep advice that can help you limit the damage, report identity theft, and fix your credit. Here are some interesting statistics that can help you understand how important it is to have the best in identity theft protection. About this form this form alerts the irs to your tax identity theft, so they can start resolving your case. Ftc identity theft affidavit printable and editable pdf. Ohio form it ta identity theft affidavit 2019 ohio. Identity theft victims complaint and affidavit a voluntary form for filing a report with law enforcement, and disputes with credit reporting agencies and creditors about identity theft related problems. Section c name and contact information of identity theft victim required victims last name. An identity theft affidavit is a document that can help victims of identity theft prove to a business that their personal financial data has been used to open a fraudulent account. Naturally, youll want to check identity theft warning signs if you suspect fraud. At the beginning of the process, the ftc allows you to choose from several options, from filing an actual identity theft report to simply notifying the ftc that your wallet was stolen and youre worried about. Identity theft is the fastest growing crime in america. Complete and submit this form if you are an actual or potential victim of identity theft and would like the franchise tax board ftb to update your account status to identify questionable activity. Omb number 154529 complete this form if you need the.
S ae ician recen ier deparen ar and ecnic ppruni e dnri ernr unepen insurance aenc direc r autoried y uia 6349 c 41. Police report statement or ftc identity theft report. Identity theft report fill out and sign printable pdf. Ask the police to issue a police report of identity theft. Identity theft victims complaint and affidavit a voluntary form for filing a report with law enforcement, and disputes with credit reporting agencies and creditors about identity theftrelated problems. Identity theft affidavit attached, a standardized form used to report new accounts fraudulently opened in your name. Uslegal received the following as compared to 9 other form sites. Fs20186, april 2018 taxpayers who experience taxrelated identity theft may wonder when they should file a form 14039, identity theft affidavit. If not, request that they send you their fraud dispute form. Tax identity theft happens when someone files a phony tax return using your personal information like your social security number to get a tax refund from the irs. Give the police as much information on the theft as possible. It can disrupt your finances,credit history, and reputation,and take time,money, and patienceto resolve. Take this form to your local law enforcement office, along with your supporting documentation to file an id theft report.
This is the same affidavit that the ftc makes available to victims of identity theft. Dec 31, 2019 fs20186, april 2018 taxpayers who experience taxrelated identity theft may wonder when they should file a form 14039, identity theft affidavit. Identity theft affidavit identity theft affidavit reset form it ta rev. Form 14039 identity theft affidavit internal revenue service. Irs has issued several recent consumer warnings on the fraudulent use of the irs name or logo by scamsters. Ftb 3552 identity theft affidavit state of california identity theft team ms a421 franchise tax board po box 2952 sacramento ca 958122952 identity theft affidavit complete and submit this form if you are an actual or potential victim of identity theft and would like the franchise. Petition for certificate of identity theft page 2 of 3 pen.
In the modern economy, sellers are willing to offer goods and services to. The advanced tools of the editor will direct you through the editable pdf template. If youve been a victim of identity theft, use this plan. Any time you think your identity has been compromised, be sure to contact the customer protection group call 18887450091. Never provide bank, credit card, or other sensitive. Place a sevenyear extended fraud alert on your credit report.
Identity theft information for tax preparers and businesses identity theft information for tax preparers publication 5199 tax preparer guide to identity theft pdf information for businesses about data breaches and identity theft what the irs is doing to combat identity theft what were doing to combat identity theft. While there are some differences in the amount of identity theft according to states and. Pdf identity theft, identity fraud andor identityrelated. When we hear of identity theft, or people stealing personal information to commit fraud, we may think of thieves stealing credit and bank information, otherwise known as financial identity. An identity theft affidavit includes personal and account information, and is a statement of the facts surrounding your identity theft.
Under louisiana law, you can report identity theft to your local police department. In the vast majority of taxrelated identity theft cases, there is no need to file the form 14039 affidavit. A copy of the ftc identity theft affidavit can be found at the end of this packet. The information i have provided in this complaint form is based upon my personal knowledge. Online technologies make it easier to arrange your file management and boost the productivity of your workflow. Phishing, pharming, and skimming are common forms of identity theft that you should be aware of. Identity theft affidavit i believe that i have been a victim of identity theft.