Identity Theft Affidavit and Police Report Cover Letter (Arizona)

IDENTITY THEFT AFFIDAVIT AND POLICE-REPORT COVER LETTER (ARIZONA)

TABLE OF CONTENTS

1. Police Report Cover Letter
2. Sworn Identity Theft Affidavit
3. Schedule A — Fraudulent Accounts and Inquiries
4. Schedule B — Documents Submitted in Support
5. Notarization
6. FCRA Blocking and Dispute Cover Letter (to Credit Bureaus and Furnishers)
7. Distribution Checklist
8. Arizona Practice Notes
9. Sources and References

1. POLICE REPORT COVER LETTER

[VICTIM FULL NAME]

[STREET ADDRESS]

[CITY, AZ ZIP]

[(___) ___-____]

Date: [__/__/____]

[LAW ENFORCEMENT AGENCY NAME]

Records / Reports Unit

[STREET ADDRESS]

[CITY, AZ ZIP]

Re: Request to Take Report of Identity Theft Pursuant to A.R.S. § 13-2008(L)

To the Officer in Charge:

I am the victim of identity theft. I respectfully request that your agency take and document a written report of this offense pursuant to Arizona Revised Statutes § 13-2008 (Taking the Identity of Another Person), § 13-2009 (Aggravated Taking the Identity of Another Person), and § 13-2008(L), which requires a peace officer to take a report on the request of the victim in any jurisdiction in which an element of the offense was committed, the result of the offense occurred, or the person whose identity was taken resides or is located.

I reside in [CITY], [COUNTY] County, Arizona. The fraudulent activity has affected accounts and transactions described in the enclosed Identity Theft Affidavit and Schedule A.

I request a copy of the police report and the case number once it is generated. I intend to use the police report together with the enclosed affidavit and FTC IdentityTheft.gov report to obtain blocks under the Fair Credit Reporting Act, 15 U.S.C. § 1681c-2.

Enclosures:

☐ Sworn Identity Theft Affidavit (notarized)

☐ Schedule A — List of fraudulent accounts and inquiries

☐ Schedule B — Supporting documents

☐ FTC IdentityTheft.gov report (Reference No.: [________________________________])

☐ Government-issued photo ID

☐ Proof of Arizona residence (utility bill, lease, or similar)

Sincerely,

[________________________________]

[VICTIM PRINTED NAME]

2. SWORN IDENTITY THEFT AFFIDAVIT

STATE OF ARIZONA

COUNTY OF [COUNTY]

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

2.1. My name is [VICTIM FULL LEGAL NAME]. My date of birth is [__/__/____]. The last four digits of my Social Security Number are [XXX-XX-____]. I currently reside at [ADDRESS], [CITY], Arizona [ZIP].

2.2. I am the victim of identity theft as that term is defined in 16 C.F.R. § 603.2 and as criminalized by A.R.S. §§ 13-2008, 13-2009, and 13-2010.

2.3. I did not authorize, consent to, or benefit from the accounts, transactions, inquiries, or other activity listed in Schedule A attached hereto and incorporated by reference.

2.4. I first discovered the identity theft on or about [__/__/____] when [describe how you discovered the theft — credit-report alert, collection call, denied credit, IRS notice, employment-screening report, etc.].

2.5. To the best of my knowledge, the personal identifying information used by the perpetrator was obtained as follows: ☐ data breach; ☐ stolen wallet/mail; ☐ phishing; ☐ family-member misuse; ☐ unknown means; ☐ other: [________________________________].

2.6. I do not know the identity of the perpetrator [OR — the perpetrator is known to me and is identified as: [NAME, RELATIONSHIP, ADDRESS]].

2.7. I have placed (or will place) a fraud alert and/or security freeze with each of the three nationwide consumer reporting agencies (Equifax, Experian, and TransUnion) pursuant to 15 U.S.C. §§ 1681c-1 and 1681c-6.

2.8. I have filed (or am filing concurrently) a report with the Federal Trade Commission via IdentityTheft.gov (Reference No.: [________________________________]).

2.9. I have not received any goods, services, money, or other benefit from the fraudulent accounts or transactions listed in Schedule A. I did not provide my consent to any person to use my identifying information for the listed activity.

2.10. I declare under penalty of perjury under the laws of the State of Arizona and the United States of America that the foregoing is true and correct to the best of my knowledge.

Executed this [____] day of [_______________], 20[____], at [CITY], Arizona.

[________________________________]

[VICTIM PRINTED NAME]

3. SCHEDULE A — FRAUDULENT ACCOUNTS AND INQUIRIES

4. SCHEDULE B — DOCUMENTS SUBMITTED IN SUPPORT

☐ Government-issued photo ID (driver license, AZ ID, passport)

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

☐ Social Security card or W-2 (last four digits redacted on copies sent to non-government recipients)

☐ Copy of consumer report showing fraudulent items (each bureau)

☐ Copies of fraudulent account statements, billing notices, or collection letters

☐ FTC IdentityTheft.gov report

☐ Police report or case number

☐ Correspondence with creditors and credit bureaus

☐ Other: [________________________________]

5. NOTARIZATION

STATE OF ARIZONA

COUNTY OF [COUNTY]

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

[________________________________]

Notary Public

My commission expires: [__/__/____]

Notary seal:

6. FCRA BLOCKING AND DISPUTE COVER LETTER (TO CREDIT BUREAUS AND FURNISHERS)

[VICTIM FULL NAME]

[ADDRESS]

[CITY, AZ ZIP]

Date: [__/__/____]

[CREDIT BUREAU / FURNISHER NAME]

[ADDRESS]

Re: Request to Block Information Resulting from Identity Theft — 15 U.S.C. § 1681c-2 / Dispute Under § 1681i

Dear Sir or Madam:

I am a victim of identity theft. Pursuant to 15 U.S.C. § 1681c-2, I request that you block from my consumer file all information identified in Schedule A attached, which resulted from the alleged identity theft. I further dispute the same items under 15 U.S.C. § 1681i.

In support of this request, I enclose:

☐ My notarized Identity Theft Affidavit;

☐ My FTC IdentityTheft.gov report (Reference No.: [__________]);

☐ A copy of the police report filed with [AGENCY] (Case No.: [__________]);

☐ A copy of my government-issued photo identification;

☐ Proof of my Arizona residence;

☐ Schedule A — List of disputed items.

Pursuant to 15 U.S.C. § 1681c-2(a), you must block the disputed information no later than four business days after receipt of this request. Pursuant to § 1681i(a), you must complete a reinvestigation within 30 days. Please confirm in writing that the block has been implemented and the items have been removed or marked as disputed.

I also request, under § 1681g(e), copies of all transaction records related to the disputed accounts.

I reserve all rights and remedies, including but not limited to claims under the Fair Credit Reporting Act, 15 U.S.C. §§ 1681n and 1681o, and the Arizona Consumer Fraud Act, A.R.S. § 44-1521 et seq.

Sincerely,

[________________________________]

[VICTIM PRINTED NAME]

7. DISTRIBUTION CHECKLIST

☐ Local police department (in person or by certified mail)

☐ Equifax — P.O. Box 105069, Atlanta, GA 30348-5069 — https://www.equifax.com/personal/credit-report-services/

☐ Experian — P.O. Box 9554, Allen, TX 75013 — https://www.experian.com/fraud/center.html

☐ TransUnion — P.O. Box 2000, Chester, PA 19016 — https://www.transunion.com/fraud-victim-resource/place-fraud-alert

☐ Each furnisher / creditor listed in Schedule A

☐ Federal Trade Commission — https://www.identitytheft.gov/

☐ Arizona Attorney General — Consumer Information and Complaints Unit, 2005 N. Central Ave., Phoenix, AZ 85004 — https://www.azag.gov/complaints/consumer

☐ Internal Revenue Service Form 14039 (if tax-related identity theft)

☐ Social Security Administration (if SSN compromised) — https://www.ssa.gov/

☐ Arizona Motor Vehicle Division (if driver license compromised) — https://azdot.gov/mvd

8. ARIZONA PRACTICE NOTES

• Police-report obligation. Under A.R.S. § 13-2008(L), peace officers in any of the listed jurisdictions "shall take a report" on the victim's request. If the agency declines, request a supervisor and cite the statute. A police report is the cornerstone of an FCRA "Identity Theft Report" (16 C.F.R. § 603.3).
• FTC report parity. Under federal rule, an FTC IdentityTheft.gov report combined with a self-affidavit can substitute for a police report when generating an "Identity Theft Report," but Arizona furnishers and bureaus often still require police-report documentation for fast removal. Get both.
• FCRA blocking. Section 1681c-2 requires bureaus to block items resulting from identity theft within four business days of receiving a complete identity-theft report. Furnishers must comply with §§ 1681s-2(a)(6) and 1681s-2(a)(7) (cease furnishing).
• Security freeze. Under 15 U.S.C. § 1681c-1 and A.R.S. § 44-1698, Arizona consumers can place free security freezes with each nationwide bureau. A freeze is more protective than a fraud alert and may be lifted temporarily.
• Statute of limitations for civil claims. Tort and statutory civil claims for identity theft generally accrue under the Arizona discovery rule. A.R.S. § 12-541(5) (one year for statutory penalties); A.R.S. § 12-542 (two years for personal injury / fraud-related torts); FCRA — two years from discovery / five years from violation, 15 U.S.C. § 1681p.
• Restitution. Victims of A.R.S. §§ 13-2008 / 13-2009 are entitled to mandatory restitution under A.R.S. § 13-603(C) and may obtain a court order clearing wrongful records under A.R.S. § 13-2008(I).
• Tax / employment identity theft. File IRS Form 14039 (Identity Theft Affidavit) and Social Security Administration Form SSA-7050-F4 if employment records are affected.

9. SOURCES AND REFERENCES

• A.R.S. § 13-2008 (Taking identity of another) — https://www.azleg.gov/ars/13/02008.htm
• A.R.S. § 13-2009 (Aggravated taking of identity) — https://www.azleg.gov/ars/13/02009.htm
• A.R.S. § 13-2010 (Trafficking in identity) — https://www.azleg.gov/ars/13/02010.htm
• A.R.S. § 44-7501 (Breach notification) — https://www.azleg.gov/ars/44/07501.htm
• 15 U.S.C. § 1681c-2 (FCRA blocking) — https://www.law.cornell.edu/uscode/text/15/1681c-2
• 16 C.F.R. § 603.3 (Identity Theft Report definition) — https://www.ecfr.gov/current/title-16/chapter-I/subchapter-F/part-603
• FTC IdentityTheft.gov — https://www.identitytheft.gov/
• Arizona Attorney General Identity Theft Resources — https://www.azag.gov/consumer/identity-theft
• Arizona DPS Identity Theft Information — https://www.azdps.gov/

Disclaimer: This template is provided for informational purposes only and does not constitute legal advice. For ongoing or large-scale identity theft, consult an Arizona-licensed attorney and follow the complete recovery plan at https://www.identitytheft.gov/.