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Affidavit of Identity Theft - Template, Sample Form

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Create your Affidavit of Identity Theft 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.

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Below you can preview the Affidavit of Identity Theft, complete it by answering a few plain-English questions, and download a ready-to-sign copy in Word and PDF - tailored for use in United States.

What the Affidavit of Identity Theft includes

This template is organised into the following sections:

Frequently asked questions

What is a Affidavit of Identity Theft?

A Affidavit of Identity Theft is a ready-to-use legal template for United States. You complete it by answering a few plain-English questions, then download the finished document in Word and PDF.

What does the Affidavit of Identity Theft cover?

The Affidavit of Identity Theft is organised into sections covering § 1. VICTIM INFORMATION, § 2. DESCRIPTION OF THE IDENTITY THEFT, § 3. LAW ENFORCEMENT ACTIONS AND AUTHORIZATION, § 4. SUPPORTING DOCUMENTATION, § 5. DECLARATION UNDER PENALTY OF PERJURY, so the important points are captured in a clear, consistent structure.

What formats can I download?

You can download your completed Affidavit of Identity Theft as an editable Microsoft Word (.docx) file and as a PDF.

Can I edit the document later?

Yes - save it to your account and you can re-open, edit and re-download it at any time.

Is a Affidavit of Identity Theft legally binding?

Once it is properly completed and signed by everyone involved, a Affidavit of Identity Theft is generally legally binding in United States, provided it meets the legal requirements that apply to this type of document.

What laws apply to a Affidavit of Identity Theft in United States?

A Affidavit of Identity Theft should comply with the laws in force in United States. This template is built around the provisions such situations commonly require, but the rules can vary by region and change over time, so check the current requirements for your case.

Do I need a lawyer to use a Affidavit of Identity Theft?

For most standard situations you can complete the Affidavit of Identity Theft yourself using the guided questionnaire. For high-value, unusual or high-risk matters, it is sensible to have a qualified lawyer review the finished document.

How do I sign the Affidavit of Identity Theft?

Download the completed Affidavit of Identity Theft as Word or PDF and sign it as required in United States. Depending on the document this may involve a handwritten or electronic signature, and some documents also need witnesses.

Is the Affidavit of Identity Theft free?

You can preview the Affidavit of Identity Theft and fill it in for free. A one-time fee applies only when you download the finished, ready-to-sign document in Word and PDF.

How long does it take to complete a Affidavit of Identity Theft?

Most people finish the Affidavit of Identity Theft in just a few minutes by answering the plain-English questions. You can save your progress and come back to it at any time.

Prepared and reviewed by the LegalDocs team.

Document preview

AFFIDAVIT OF IDENTITY THEFT

(Declaration Pursuant to 28 U.S.C. § 1746 and Applicable State Law)

STATE OF ________

COUNTY OF ________

I, ________, being first duly sworn, depose and state as follows:

§ 1. VICTIM INFORMATION

  1. My full legal name is ________, and I was born on ________.
  2. The last four digits of my Social Security Number are ________.
  3. My driver's license or state-issued identification number is ________, issued by the State of ________.
  4. I have resided at the following address since ________:

________

  1. My prior address, if I have resided at my current address for less than two (2) years, is:

________

  1. The best way to contact me is as follows (telephone, email, and/or mailing address):

________

§ 2. DESCRIPTION OF THE IDENTITY THEFT

  1. I did not authorize anyone to use my name or personal information to obtain money, credit, loans, goods, services, or any other benefit, and I am a victim of identity theft within the meaning of 18 U.S.C. § 1028 and applicable state law.
  2. The identity theft occurred on or about ________, and was discovered by me on or about ________.
  3. The identity theft occurred in the following manner:

________

  1. The following accounts, transactions, or instruments were fraudulently opened, accessed, or used without my knowledge or authorization (including creditor names, account numbers, and amounts where known):

________

________

§ 3. LAW ENFORCEMENT ACTIONS AND AUTHORIZATION

  1. I am willing to assist, to the best of my ability, in the investigation and prosecution of the person or persons who committed this fraud.
  3. I have reported, or will report, this matter to law enforcement. The report was made to ________ on ________, and was assigned report or case number ________. A copy of the report is attached to this Affidavit, if available.

§ 4. SUPPORTING DOCUMENTATION

  1. I am providing the following supporting documentation in connection with this Affidavit:

________

§ 5. DECLARATION UNDER PENALTY OF PERJURY

I declare under penalty of perjury under the laws of the United States of America and the State of ________ that the foregoing statements are true and correct to the best of my knowledge, information, and belief. I understand that knowingly making a false statement in this Affidavit may subject me to criminal penalties under 18 U.S.C. § 1001 and applicable state law.

IN WITNESS WHEREOF, I have executed this Affidavit of Identity Theft on the date set forth below.


_________________________________
________
Affiant Signature


Date: ________

NOTARY ACKNOWLEDGMENT

State of ________, County of ________.

Subscribed and sworn (or affirmed) to before me on this ________ day of ________, ________, by ________, who is personally known to me or who produced ________ as identification.


_________________________________
Signature, Notary Public

Printed Name: ________

My commission expires: ________

(Notary Seal)

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