LegalDocs

Affidavit of Identity Theft - Template, Sample Form

✓ Valid in United States

Create your Affidavit of Identity Theft - Template, Sample Form for use in United States. Answer a few plain-English questions and the document fills in automatically as you go — then download it in Word and PDF, ready to sign or share.

  • Answer 10 simple questions — the document fills in as you go
  • Live preview: watch your document update in real time
  • Download as Word (.docx) and PDF
  • Edit your answers and re-download anytime
Save to access it later, on any device.

Fill in the details

0/10

Type below — the document on the right updates as you go.

Affidavit of Identity Theft - Template, Sample Form
🔒The clauses below are blurred in the preview. Fill in your details, then pay once to unlock the full document and download it as Word & PDF.

AFFIDAVIT OF IDENTITY THEFT

Victim Information:

My full legal name is ________ and I was born on ________. My social security number is ________. My driver's license or state ID number is ________.

I have lived at the following address since ________:

________

The best way to contact me is through the following:

________

Description of Identity Theft:

The identity theft happened in the following manner:

________

________

Law Enforcement Actions:

I am willing to assist to the best of my abilities in the prosecution of the person(s) who committed this fraud.

I am authorizing the release of this information to any law enforcement officials for the purpose of assisting them in their investigation and prosecution of any persons involved in this fraud.

I have reported this fraud to the police or other law enforcement agencies. I have attached the police report to this affidavit.

Supporting Documentation:

I am providing the following supporting documentation:

________

In witness whereof, I have executed this Affidavit of Identity Theft on the date set forth below.



_________________________________
________


____________
Date


Subscribed and sworn (or affirmed) to before me on this ______ day of ___________________, ________.


_________________________________
Signature, Notary Public

Fields you complete are inserted into the document live. This template is general guidance only — not legal advice.