________
________
Telephone: ________
Email: ________
Date: ________
Internal Revenue Service
Attn: Identity Theft Victim Assistance / Criminal Investigation Division
________
Re: Notice of Identity Theft and Fraudulent Tax Filing — Taxpayer SSN ending in ________
Tax Year(s) Affected: ________
To Whom It May Concern:
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§ 2. Prior Contact with the IRS. This letter follows up on my prior communication with ________, ID #________, which occurred on ________. The reference or case number assigned to my matter, if any, is ________.
§ 3. Taxpayer Identification. To verify my identity, I provide the following information:
Full legal name: ________
Social Security Number: ________
Date of birth: ________
Current mailing address: ________
Address(es) used on prior tax returns, if different: ________
§ 4. Discovery of the Fraud. The manner in which I discovered this tax fraud is described as follows:
________
§ 5. Nature of the Fraudulent Activity. The nature of the fraudulent tax filing and any related unauthorized use of my personal information is described as follows:
________
§ 6. Related Reports and Filings. I have also taken the following protective measures in connection with this incident, copies or reference numbers of which are noted where applicable:
Federal Trade Commission Identity Theft Report (IdentityTheft.gov) reference: ________
Police report jurisdiction and number: ________
Credit bureau fraud alert / security freeze placed on: ________
§ 7. Enclosed Documentation. Enclosed are copies of the following documents, provided as evidence and documentation of the identity theft incident:
________
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§ 9. Cooperation. I understand the seriousness of this matter and am committed to cooperating fully with any investigation into this fraudulent activity. Please advise me of any additional steps I should take to protect my identity and resolve this issue. I would also appreciate written confirmation that my account has been flagged and that the necessary corrections have been made.
§ 10. Declaration. I declare, under penalty of perjury under the laws of the United States of America pursuant to 28 U.S.C. § 1746, that the foregoing statements and the enclosed documentation are true, correct, and complete to the best of my knowledge and belief.
§ 11. Contact. Please contact me at the address or telephone number listed above if you have any questions or require additional information. Thank you for your prompt attention to this urgent matter.
Respectfully,
________
Signature: ____________________________
Date signed: ________
Enclosures: As described in § 7 above.