Elder Financial Exploitation Report

Elder Financial Exploitation Report

Purpose

This template provides a structured format for documenting and reporting suspected financial exploitation of elderly or vulnerable adults to appropriate authorities, including Adult Protective Services, law enforcement, and financial institutions.

What is Elder Financial Exploitation?

State and territorial definitions of financial exploitation differ. For intake purposes, this report uses a broad working description: financial abuse by someone known to the older adult or financial fraud by a stranger that wrongfully takes, controls, or uses the person's money, property, or resources. Possible indicators include:

• Theft of money or belongings
• Forging signatures on checks or documents
• Coercing someone to sign legal documents (wills, deeds, POA)
• Unauthorized use of credit cards or bank accounts
• Scams and fraud targeting seniors
• Misuse of Power of Attorney
• Undue influence over financial decisions
• Identity theft
• Investment fraud
• Predatory lending

Use the current official definition for the state or territory where the affected person lives; age thresholds and coverage of adults with disabilities vary.

Part 1: Victim Information

Elder/Vulnerable Adult Information

Victim's Living Situation

☐ Lives alone
☐ Lives with spouse/partner
☐ Lives with family member (Relationship: _____________)
☐ Lives with caregiver
☐ Lives in assisted living facility
☐ Lives in nursing home
☐ Other: _________________________________

Victim's Capacity Status

☐ Believed to have full mental capacity
☐ Suspected cognitive impairment
☐ Diagnosed with dementia/Alzheimer's
☐ Has guardian/conservator (Name: _________________)
☐ Has Power of Attorney (Agent: _________________)
☐ Unknown

Victim's Vulnerability Factors

☐ Social isolation
☐ Cognitive decline
☐ Physical disability
☐ Dependence on others for care
☐ Recent loss of spouse/family member
☐ Depression or mental health issues
☐ Limited English proficiency
☐ Low financial literacy
☐ Other: _________________________________

Part 2: Reporter Information

Person Filing This Report

Reporter Category

☐ Family member
☐ Friend/neighbor
☐ Healthcare provider
☐ Social worker
☐ Financial institution employee
☐ Attorney
☐ Law enforcement
☐ Clergy
☐ Other: _________________________________

Mandated Reporter Status

☐ I am a mandated reporter in my state
☐ I am NOT a mandated reporter
☐ Unsure of mandated reporter status

State-law check required: Mandatory-reporter categories, reportable conduct, deadlines, reporting methods, confidentiality, and immunity vary. Confirm them through the affected jurisdiction's official APS statute and agency instructions before deciding whether or how to report.

Part 3: Suspected Perpetrator Information

Alleged Perpetrator Details

Perpetrator's Relationship to Victim

☐ Adult child
☐ Grandchild
☐ Other family member (Relationship: _____________)
☐ Spouse/partner
☐ Caregiver (paid)
☐ Caregiver (unpaid)
☐ Friend/acquaintance
☐ Neighbor
☐ Financial advisor/professional
☐ Attorney
☐ Stranger
☐ Unknown
☐ Other: _________________________________

Perpetrator's Access to Victim

☐ Lives with victim
☐ Has regular access to victim's home
☐ Is named as Power of Attorney
☐ Is authorized user on bank accounts
☐ Manages victim's finances
☐ Provides care/assistance to victim
☐ Has access to victim's mail
☐ Other: _________________________________

Part 4: Type of Financial Exploitation

Categories of Suspected Exploitation (check all that apply)

Theft and Fraud:
☐ Theft of cash
☐ Theft of checks
☐ Theft of credit/debit cards
☐ Theft of personal property/belongings
☐ Forged signatures on checks
☐ Forged signatures on legal documents
☐ Identity theft
☐ Unauthorized use of ATM/debit card
☐ Unauthorized credit card charges

Misuse of Authority:
☐ Misuse of Power of Attorney
☐ Misuse of representative payee authority
☐ Misuse of guardianship/conservatorship
☐ Coerced changes to will
☐ Coerced changes to beneficiary designations
☐ Coerced property transfers
☐ Undue influence over financial decisions

Scams and Fraud:
☐ Lottery/sweepstakes scam
☐ Grandparent scam
☐ Romance scam
☐ IRS/government impersonation scam
☐ Tech support scam
☐ Investment fraud
☐ Contractor/home repair fraud
☐ Medicare/insurance fraud
☐ Charity scam
☐ Other scam: _________________________________

Real Estate:
☐ Deed theft
☐ Fraudulent property transfer
☐ Predatory lending/reverse mortgage fraud
☐ Home equity theft

Other:
☐ Other exploitation: _________________________________

Part 5: Detailed Description of Exploitation

Timeline of Events

Narrative Description

Describe in detail what happened, including:

• How you became aware of the exploitation
• What specific actions were taken by the perpetrator
• What financial loss or damage occurred
• Impact on the victim
• Any statements made by the victim or perpetrator

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

Estimated Financial Loss

Ongoing Exploitation

☐ Exploitation appears to have stopped
☐ Exploitation is ongoing
☐ Future exploitation is likely if not stopped

Part 6: Evidence and Documentation

Available Evidence (check all that apply)

Financial Documents:
☐ Bank statements showing unauthorized transactions
☐ Credit card statements
☐ Cancelled checks (original or copies)
☐ ATM/debit card records
☐ Wire transfer records
☐ Investment account statements
☐ Tax returns

Legal Documents:
☐ Power of Attorney document
☐ Changed will or trust
☐ Property deeds
☐ Contracts or agreements
☐ Loan documents

Communications:
☐ Letters or mail
☐ Emails
☐ Text messages
☐ Voicemails
☐ Social media messages/posts

Other Evidence:
☐ Photographs
☐ Lawfully obtained video recordings
☐ Witness statements
☐ Police reports
☐ Previous incident reports
☐ Other: _________________________________

Evidence Preservation

☐ Original documents secured
☐ Copies made for filing
☐ Electronic evidence preserved
☐ Chain of custody documented

Evidence Storage Location: _________________________________

Part 7: Witnesses

People with Knowledge of the Exploitation

Statements from Victim

Has the victim made statements about the exploitation?
☐ Yes ☐ No ☐ Victim unable to communicate

If yes, describe what the victim has said:

__________________________________________________________________

__________________________________________________________________

Part 8: Prior Reports or Protective Measures

Previous Reports

☐ No previous reports filed
☐ Previous reports filed:

Existing Protective Measures

☐ Guardianship/Conservatorship in place
☐ Protective order in place
☐ Bank account monitoring established
☐ Credit freeze in place
☐ Other: _________________________________

Part 9: Reporting to Agencies

Adult Protective Services (APS)

APS or another state-designated agency commonly receives reports involving adults covered by that jurisdiction's protective-services law. Confirm the correct agency, eligibility definition, and reporting method for the affected person's location.

National Elder Fraud Hotline: 1-833-FRAUD-11 (1-833-372-8311)

Law Enforcement

District Attorney/Prosecutor

Financial Institution Notification

If exploitation involves bank accounts, notify the bank immediately

Questions or Requests for the Bank's Fraud/Security Team:
☐ Review recent transactions and preserve relevant account records
☐ Explain safeguards available to the account holder or an authorized representative
☐ Explain whether a transaction hold or disbursement delay is available under applicable law
☐ Review authorized users, account credentials, alerts, and account-number changes with a person authorized to act
☐ Provide instructions for disputing unauthorized electronic transfers or other transactions

SAR confidentiality: A financial institution independently determines whether to file a Suspicious Activity Report. Do not ask the institution to confirm whether it filed or will file one; federal law generally prohibits disclosure of a SAR or information revealing its existence.

Other Agencies

State Banking/Financial Regulator:

State Attorney General:

Federal Trade Commission (FTC):

Consumer Financial Protection Bureau (CFPB):

Part 10: Immediate Protective Actions

Actions to Protect the Victim

☐ Contact the bank's fraud/security team and ask what safeguards are available to the account holder or an authorized representative
☐ Change passwords on financial accounts
☐ Consider a credit freeze or fraud alert using the current instructions linked by the Federal Trade Commission
☐ Contact credit card companies
☐ Secure important documents
☐ Change locks if perpetrator had access
☐ Ask each institution what proof of authority it requires before changing account access
☐ Obtain state-specific legal advice before attempting to revoke or replace a Power of Attorney
☐ Set up mail forwarding to safe address
☐ Notify Social Security (if checks being stolen)
☐ Contact local Area Agency on Aging for resources

Safety Planning

☐ Victim is currently safe from perpetrator
☐ Victim may need relocation
☐ Victim needs in-home support services
☐ Seek prompt state-specific legal advice about emergency protective proceedings if the person may lack capacity

Part 11: State-Law Verification Checklist

Before filing or requesting protective action, verify each item against the current official law and agency instructions for the affected person's state or territory:

☐ Definition of a protected adult and any age, disability, residence, or capacity threshold
☐ Definition of financial exploitation and the facts that trigger an APS report
☐ Whether the reporter is mandatory or voluntary
☐ Reporting deadline, required information, and permitted reporting method
☐ Confidentiality, reporter-identity, good-faith immunity, and false-report provisions
☐ Whether a financial institution or securities professional has a separate reporting duty
☐ Authority and conditions for a transaction hold or disbursement delay
☐ Emergency court, law-enforcement, guardianship, conservatorship, or protective-order options
☐ Whether tribal, territorial, facility, long-term-care-ombudsman, or licensing-agency procedures also apply

Trusted Contact Provisions

Some financial institutions offer trusted-contact designations. Ask the institution what its designation does, who may create or change it, and whether it authorizes transactions (a trusted-contact designation ordinarily serves a different function from account authority or a Power of Attorney).

☐ Trusted contact designated at bank: _________________________________
☐ Trusted contact designated at brokerage: _________________________________
☐ Trusted contact should be added

Part 12: Sample Report Letter to APS

[DATE]

Adult Protective Services
[ADDRESS]
[CITY, STATE ZIP]

RE: Report of Suspected Elder Financial Exploitation
Victim: [VICTIM NAME]
Date of Birth: [DOB]

Dear Adult Protective Services:

I am writing to report suspected financial exploitation of [Victim Name], a [age]-year-old [man/woman] residing at [address]. I am the victim's [relationship] and I am a [mandated reporter/concerned family member].

VICTIM INFORMATION:
[Provide victim's name, DOB, address, phone, and living situation]

SUSPECTED PERPETRATOR:
[Name], who is the victim's [relationship], is believed to be financially exploiting [him/her]. The perpetrator [describe relationship and access to victim].

DESCRIPTION OF EXPLOITATION:
I believe financial exploitation is occurring based on the following:

[Describe specific incidents, dates, amounts, and how you became aware]

EVIDENCE:
The following evidence supports this report:

• [List evidence available]

FINANCIAL IMPACT:
The estimated financial loss is approximately $[amount], including [describe types of losses].

VICTIM'S CAPACITY:
[Describe victim's mental status and ability to protect themselves]

PRIOR REPORTS:
[Note any prior reports to agencies]

IMMEDIATE CONCERNS:
[Describe any urgent safety or financial concerns]

I request that APS investigate this matter and take appropriate action to protect [Victim Name] from further exploitation.

Please contact me at [phone] or [email] if you need additional information.

Sincerely,

_________________________________
[Your Signature]

[Your Printed Name]
[Your Address]
[Your Phone]
[Your Email]

Part 13: Follow-Up Tracking

Report Follow-Up Log

Investigation Status

☐ Under investigation
☐ Investigation closed - substantiated
☐ Investigation closed - unsubstantiated
☐ Criminal charges filed
☐ Civil action initiated
☐ Restitution ordered
☐ Protective measures implemented

Part 14: Resources

National Resources

State/Local Resources

Signatures

Reporter Certification:

I certify that the factual information in this report is true and accurate to the best of my knowledge. I have reviewed the reporting instructions that apply in the relevant state or territory.

Signature: _________________________________ Date: _______________

Print Name: _________________________________

Sources and References

• U.S. Department of Justice Elder Justice Initiative — Financial Exploitation
• U.S. Department of Justice — Find Help or Report Abuse
• U.S. Department of Justice — State Elder Abuse Statutes and reporting-law resources
• Administration for Community Living — Eldercare Locator
• Federal financial regulators — interagency statement on elder financial exploitation, revised June 2026
• 31 U.S.C. § 5318(g) — suspicious-transaction reports and nondisclosure
• 31 C.F.R. § 1020.320 — bank suspicious-activity reports and confidentiality
• FinCEN — 2025 SAR-confidentiality guidance
• Federal Trade Commission — Credit Freezes and Fraud Alerts
• Federal Trade Commission — ReportFraud
• Consumer Financial Protection Bureau — Submit a Complaint
• FBI Internet Crime Complaint Center

This template is for informational purposes only and does not constitute legal advice. Call 911 for immediate danger. For other suspected exploitation, use the current official reporting instructions for the affected person's state or territory and consult qualified counsel when legal authority, capacity, account access, or emergency court relief is at issue.