Your answers are saved on this device — never on our servers · Sign in

Fill in the details

0/10

0 of 10 completed

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

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.

Proceed to payment

🔒 Secure & private · ⚡ Instant download after payment · One-time payment · no subscription

Affidavit of Identity Theft - Template, Sample Form

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.