Notification of Fraudulent Tax Filing - Template Form

________
________
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:

§ 1. Purpose of This Notice. This letter is submitted to formally report that I have been the victim of identity theft and that my personal identifying information has been used, without my authorization, in connection with one or more fraudulent federal income tax filings. This notice is provided pursuant to 26 U.S.C. § 6103 and the procedures established by the Internal Revenue Service for identity theft victims, and is intended to supplement IRS Form 14039 (Identity Theft Affidavit), a copy of which is enclosed herewith.

§ 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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§ 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.