Identity Theft Affidavit and Police Report Cover - Arkansas

IDENTITY THEFT AFFIDAVIT AND POLICE REPORT COVER PACKET — ARKANSAS

TABLE OF CONTENTS

1. Cover Letter to Law Enforcement
2. Victim Information
3. Affidavit of Identity Theft (Notarized)
4. Schedule of Fraudulent Accounts and Transactions
5. Documents Attached / Enclosed
6. Demand for Police Report and Identity Theft Passport
7. Notice to Creditors and Consumer Reporting Agencies
8. Recovery Action Checklist
9. Arkansas Practice Notes
10. Sources and References

1. COVER LETTER TO LAW ENFORCEMENT

Date: [__/__/____]

To: [POLICE DEPARTMENT / SHERIFF'S OFFICE]

Address: [STREET ADDRESS, CITY, AR ZIP]

Re: Report of Identity Fraud Pursuant to Ark. Code Ann. §§ 5-37-227 and 5-37-228

Dear Officer / Records Custodian:

I, [VICTIM FULL LEGAL NAME], am the victim of identity fraud. I hereby request that your agency take a written police report under Ark. Code Ann. § 5-37-228(c), which requires local law enforcement to take such a report whether or not the agency has jurisdiction over the suspected crime, and to provide me a copy of the report.

Enclosed is my notarized Affidavit of Identity Theft, supporting documentation, and a Schedule of Fraudulent Accounts and Transactions. I respectfully request:

☐ A police-report case number;

☐ A copy of the completed report;

☐ Referral, if appropriate, to the Arkansas Attorney General's Identity Theft Unit for issuance of an Arkansas Identity Theft Passport under Ark. Code Ann. § 5-37-228;

☐ Forwarding to the proper investigative agency if jurisdiction lies elsewhere.

Thank you for your prompt attention.

Sincerely,

[________________________________]

[VICTIM NAME]

2. VICTIM INFORMATION

3. AFFIDAVIT OF IDENTITY THEFT (NOTARIZED)

STATE OF ARKANSAS

COUNTY OF [________________________________]

I, [VICTIM FULL LEGAL NAME], being first duly sworn upon oath, depose and state as follows:

3.1. I am over the age of eighteen, of sound mind, and competent to make this affidavit. The facts stated are within my personal knowledge and are true and correct.

3.2. I am a resident of [CITY], [COUNTY] County, Arkansas. My identifying information is set out in Section 2 above.

3.3. I am the victim of identity fraud as defined by Ark. Code Ann. § 5-37-227. An unknown person (or persons) used my personal identifying information without my permission, knowledge, or authorization.

3.4. I did not authorize any person to use my name, Social Security number, date of birth, address, financial-account numbers, driver's-license number, or other identifying information to obtain credit, goods, services, money, property, employment, medical care, or government benefits, or for any other purpose, except as listed in the chart at Section 4 below as "Authorized."

3.5. I first discovered the identity fraud on or about [DATE] when [describe — e.g., received a collection call, reviewed credit report, received a bill, was denied credit, was contacted by employer or law-enforcement officer, etc.].

3.6. I have not been charged, convicted, or arrested for any conduct relating to the fraudulent activity described in Section 4 below, and I did not consent to or benefit from such conduct.

3.7. I do not know the perpetrator. [OR] I believe the perpetrator may be [name and relationship if known] based on [basis of belief].

3.8. I have taken or will promptly take the following actions:

☐ Filed a report with the Federal Trade Commission at IdentityTheft.gov (FTC Report Number: [________________________________]);

☐ Placed an initial 1-year fraud alert with one of the three nationwide consumer reporting agencies under 15 U.S.C. § 1681c-1;

☐ Placed a security freeze with each of Equifax, Experian, and TransUnion under 15 U.S.C. § 1681c-1(i);

☐ Notified each creditor or financial institution listed in Section 4;

☐ Filed this report with [LAW ENFORCEMENT AGENCY] on [__/__/____], Case No. [________________________________];

☐ Applied for an Arkansas Identity Theft Passport from the Arkansas Attorney General under Ark. Code Ann. § 5-37-228.

3.9. I make this affidavit so that creditors, banks, employers, consumer reporting agencies, and law-enforcement agencies will block, remove, investigate, and prosecute fraudulent activity associated with my identity, and so that the records of the fraudulent activity will not be attributed to me.

3.10. I understand that knowingly making a false statement in this affidavit may subject me to criminal prosecution under Arkansas and federal law.

Further, affiant sayeth not.

[________________________________]

[VICTIM NAME], Affiant

Date: [__/__/____]

ACKNOWLEDGMENT

State of Arkansas

County of [________________________________]

Subscribed and sworn to (or affirmed) before me on this [____] day of [_______________], 20[____], by [VICTIM NAME], who is personally known to me or who produced [FORM OF ID] as identification.

[________________________________]

Notary Public

My commission expires: [__/__/____]

(Notary seal)

4. SCHEDULE OF FRAUDULENT ACCOUNTS AND TRANSACTIONS

Suspected medium of compromise (check all that apply):

☐ Stolen wallet/purse ☐ Mail theft ☐ Phishing email/text ☐ Phone scam ☐ Data breach (Ark. Code Ann. § 4-110-105 notice received from [ENTITY] dated [__/__/____]) ☐ Lost/stolen device ☐ Skimmer/card cloning ☐ Insider/known person ☐ Unknown

5. DOCUMENTS ATTACHED / ENCLOSED

☐ Government-issued photo ID (driver's license / state ID / passport)

☐ Proof of current address (utility bill, lease, mortgage statement)

☐ FTC Identity Theft Report (IdentityTheft.gov)

☐ Credit reports from Equifax, Experian, TransUnion (with fraudulent items circled)

☐ Account statements showing fraudulent transactions

☐ Correspondence from creditors / collection agencies

☐ Data-breach notice(s) received under Ark. Code Ann. § 4-110-105

☐ Affidavits from witnesses (if any)

☐ Other: [________________________________]

6. DEMAND FOR POLICE REPORT AND IDENTITY THEFT PASSPORT

Pursuant to Ark. Code Ann. § 5-37-228(c), I respectfully demand that your agency:

1. Take a written police report of the matter described in this packet, whether or not your agency has jurisdiction over the suspected crime;
2. Provide me a copy of the completed report; and
3. Forward my application materials, upon completion of the report, to the Arkansas Attorney General's Office for issuance of an Arkansas Identity Theft Passport under § 5-37-228, which I may present to any law-enforcement officer, creditor, or other entity to assist in establishing my innocence and identity.

7. NOTICE TO CREDITORS AND CONSUMER REPORTING AGENCIES

A copy of this affidavit, together with a certified copy of the police report and the FTC Identity Theft Report, will be transmitted to each creditor and each nationwide consumer reporting agency.

Pursuant to the Fair Credit Reporting Act:

• 15 U.S.C. § 1681c-2 — CRAs must block information resulting from identity theft within four business days after receiving the consumer's identification, an Identity Theft Report, and the consumer's statement that the information is not the result of any transaction by the consumer;
• 15 U.S.C. § 1681s-2(a)(6) — Furnishers must cease furnishing information after notice that the information results from identity theft;
• 15 U.S.C. § 1681g(e) — Business entities must provide the victim, upon request and submission of an Identity Theft Report, with copies of application and transaction records relating to the identity theft, free of charge.

Failure to comply gives rise to private actions under the FCRA and may also constitute a deceptive trade practice under Ark. Code Ann. § 4-88-107.

8. RECOVERY ACTION CHECKLIST

Within 24-72 hours:

☐ File FTC report at IdentityTheft.gov

☐ Place initial 1-year fraud alert with one CRA (the CRA must notify the other two)

☐ Contact each affected creditor's fraud department; close fraudulent accounts in writing

☐ Change passwords / PINs on all financial accounts

☐ File this affidavit with local Arkansas law enforcement

Within 30 days:

☐ Place a security freeze with each of Equifax, Experian, TransUnion (free under FCRA)

☐ Submit Identity Theft Report packet to each CRA demanding § 1681c-2 block

☐ Send § 1681g(e) requests to creditors for application and transaction records

☐ Apply for Arkansas Identity Theft Passport from Arkansas AG (§ 5-37-228)

☐ Notify Social Security Administration if SSN misused (1-800-269-0271)

☐ Notify Arkansas Department of Finance and Administration if driver's license / state ID misused

☐ Report tax-related identity theft via IRS Form 14039

☐ Notify USPIS if mail theft suspected

Ongoing:

☐ Review credit reports quarterly

☐ Document every communication (date, time, person, content)

☐ Retain all certified-mail receipts

☐ Track all out-of-pocket expenses (potentially recoverable as restitution under § 5-37-227)

9. ARKANSAS PRACTICE NOTES

• Mandatory police report. Ark. Code Ann. § 5-37-228(c) obligates Arkansas local law enforcement to take an identity-theft report on the victim's request, regardless of jurisdiction. Cite the statute if a department initially refuses.
• Identity Theft Passport. The Arkansas Attorney General issues an Identity Theft Passport under § 5-37-228 that the victim may present to law enforcement and creditors to help establish innocence and identity. The application process runs through the Arkansas AG's Public Protection Division.
• Restitution. Under Ark. Code Ann. § 5-37-227(c), a court convicting a defendant of identity fraud may order restitution to the victim, including out-of-pocket losses, attorney fees, and lost wages from time spent restoring identity.
• Venue. Identity-fraud prosecutions may be venued in any county where any element of the offense occurred or where the victim resides (§ 5-37-227(d)).
• Penalties. Financial identity fraud is a Class C felony (Class B if victim is elderly or disabled). Nonfinancial identity fraud is a Class D felony (Class C if victim is elderly or disabled). Ark. Code Ann. § 5-37-227(b).
• PIPA breach notice. Under Ark. Code Ann. § 4-110-105, businesses must notify Arkansas residents whose unencrypted personal information was acquired without authorization, and must notify the Arkansas Attorney General if the breach affects more than 1,000 individuals (within 45 days). Keep any breach-notice letter as evidence of the compromise vector.
• Limitations. No specific civil SOL for identity-theft restitution by victims; FCRA private actions must be brought within 2 years of discovery / 5 years of violation (15 U.S.C. § 1681p). ADTPA actions: 5 years (Ark. Code Ann. § 4-88-115).
• Free credit freezes. Federal law (15 U.S.C. § 1681c-1(i)) makes placing and lifting credit freezes free at all three nationwide CRAs.
• Fraud alerts and military. Active-duty military members may place an "active duty alert" under § 1681c-1(c). Extended (7-year) alerts available with an Identity Theft Report.

10. SOURCES AND REFERENCES

• Ark. Code Ann. § 5-37-227 (financial / nonfinancial identity fraud) — https://law.justia.com/codes/arkansas/title-5/subtitle-4/chapter-37/subchapter-2/section-5-37-227/
• Ark. Code Ann. § 5-37-228 (Identity Theft Passport) — https://law.justia.com/codes/arkansas/title-5/subtitle-4/chapter-37/subchapter-2/section-5-37-228/
• Arkansas Personal Information Protection Act, Ark. Code Ann. §§ 4-110-101 to 4-110-108 — https://law.justia.com/codes/arkansas/title-4/subtitle-7/chapter-110/
• Ark. Code Ann. § 4-110-105 (data-breach notification) — https://law.justia.com/codes/arkansas/title-4/subtitle-7/chapter-110/section-4-110-105/
• Arkansas Attorney General — Identity Theft Resources — https://arkansasag.gov/divisions/public-protection/identity/
• Arkansas AG Data Breach Reporting — https://arkansasag.gov/divisions/public-protection/identity/security-or-data-breach/data-breach-reporting-form/
• 18 U.S.C. § 1028 (federal identity-fraud statute) — https://www.law.cornell.edu/uscode/text/18/1028
• 15 U.S.C. § 1681c-1 (fraud alerts and freezes) — https://www.law.cornell.edu/uscode/text/15/1681c-1
• 15 U.S.C. § 1681c-2 (block of information resulting from identity theft) — https://www.law.cornell.edu/uscode/text/15/1681c-2
• 15 U.S.C. § 1681g(e) (consumer's right to records of identity theft) — https://www.law.cornell.edu/uscode/text/15/1681g
• FTC IdentityTheft.gov — https://www.identitytheft.gov/
• FTC Identity Theft Affidavit (Form) — https://www.identitytheft.gov/Assistant
• IRS Form 14039 (Identity Theft Affidavit) — https://www.irs.gov/forms-pubs/about-form-14039

Disclaimer: This template is provided for informational purposes only and does not constitute legal advice. An attorney licensed in Arkansas should review and customize this document before use. Laws, citations, and forms change frequently; verify all authorities before submission.