Florida's Identity Theft Victim Kit

Victim’s Law Enforcement Actions
(17)(check one) I am am not willing to assist in the prosecution of the person(s) who
committed this fraud.
(18)(check one) I am am not authorizing the release of this information to law enforce-
ment for the purpose of assisting them in the investigation and prosecution of the person(s) who com-
mitted 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:
_____________________________ _________________________________
(Agency #1) (Officer/Agency personnel taking report)
____________________________ _________________________________
(Date of report) (Report Number, if any)
_____________________________ _________________________________
(Phone number) (e-mail address, if any)
_____________________________ _________________________________
(Agency #2) (Officer/Agency personnel taking report)
_____________________________ _________________________________
(Date of report) (Report Number, if any)
_____________________________ _________________________________
(Phone number) (e-mail address, if any)
Documentation Checklist
Please indicate the supporting documentation you are able to provide to the companies you plan to
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).
Name __________________________________ Phone number _______________________ Page 3
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Florida's Identity Theft Victim Kit PDF

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