Identity Theft Affidavit and Police Report Cover - Colorado

IDENTITY THEFT AFFIDAVIT AND POLICE REPORT COVER — COLORADO

TABLE OF CONTENTS

1. Part A — Police Report Cover Letter
2. Part B — Sworn Identity Theft Affidavit
3. Part C — Notification Letters to Consumer-Reporting Agencies
4. Part D — Notification Letters to Furnishers
5. Colorado Practice Notes
6. Sources and References

1. PART A — POLICE REPORT COVER LETTER

[VICTIM NAME]

[STREET ADDRESS]

[CITY, COLORADO ZIP]

[TELEPHONE] [EMAIL]

Date: [__/__/____]

[LAW-ENFORCEMENT AGENCY — e.g., Denver Police Department, [_____] County Sheriff's Office]

Records / Identity Theft Unit

[STREET ADDRESS]

[CITY, COLORADO ZIP]

Re: Request to File Identity Theft Report — Colorado Victim

Dear Records Officer:

I am a Colorado resident and the victim of identity theft. I am requesting that your agency take a police report, provide me with a copy, and begin an investigation as required by C.R.S. § 16-5-103(4) when the agency has jurisdiction over my residence or the place where the suspected crime occurred. I am also requesting a report that can be evaluated under the federal Fair Credit Reporting Act, 15 U.S.C. § 1681a(q).

The attached affidavit describes:

• ☐ The unauthorized use of my personal identifying information;
• ☐ The unauthorized use of my financial identifying information;
• ☐ The unauthorized use of one or more of my financial devices;
• ☐ The opening of fraudulent credit accounts;
• ☐ Existing-account takeover or unauthorized transactions;
• ☐ Government-document or benefit fraud;
• ☐ Tax-return identity theft;
• ☐ Medical identity theft;
• ☐ Other: [_______________________________].

Conduct of this nature is criminal under C.R.S. § 18-5-902 (identity theft), C.R.S. § 18-5-904 (gathering identity information by deception), and/or C.R.S. § 18-5-905 (possession of identity-theft tools).

I request that the report be assigned a case number and that I be provided with:

1. The case number;
2. A certified copy of the report; and
3. The name and contact information of the assigned investigator.

I have also filed a Federal Trade Commission Identity Theft Report at IdentityTheft.gov (FTC report number: [_______________]), a copy of which is enclosed. Together with this police report, I will submit the package to the consumer-reporting agencies under 15 U.S.C. § 1681c-2 to obtain an information block.

Thank you for your assistance.

Sincerely,

[________________________________]

[VICTIM NAME]

Enclosures: Sworn Identity Theft Affidavit; FTC Identity Theft Report; copies of supporting documentation (account statements, fraudulent applications, correspondence).

2. PART B — SWORN IDENTITY THEFT AFFIDAVIT

STATE OF COLORADO

COUNTY OF [_______________]

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

A. Identification of Affiant

1. My full legal name is [_______________________________].

2. My date of birth is [__/__/____].

3. My residential address is [_______________________________], [CITY], Colorado [ZIP].

4. The last four digits of my Social Security number are [XXX-XX-_____].

5. My Colorado driver's license / ID number is [_______________] (issued [__/__/____]).

B. Statement of Identity Theft

6. I am the victim of identity theft. I did not authorize, consent to, or benefit from the transactions, accounts, or activity described below. I had no relationship with any of the persons or entities that committed the fraudulent acts.

7. I first discovered the identity theft on or about [__/__/____] when [DESCRIBE — e.g., I received a credit-card statement for an account I never opened; I was denied credit and pulled my credit report; I received an IRS notice; I received a debt-collection call].

8. To the best of my knowledge, the identity thief obtained my personal identifying information by [DESCRIBE — e.g., a data breach at [COMPANY]; a stolen wallet on [DATE]; phishing email; unknown means].

C. Fraudulent Accounts and Transactions

9. The following accounts, transactions, or items are fraudulent and were not authorized by me:

10. I have circled and identified these items on the credit reports attached to this affidavit (Equifax, Experian, and TransUnion).

D. Police Report

11. I have filed or am concurrently filing a police report with [LAW-ENFORCEMENT AGENCY] in [CITY/COUNTY], Colorado.

12. The case number assigned is [_______________] (if known; otherwise, "to be assigned").

13. I have filed or am concurrently filing a Federal Trade Commission Identity Theft Report at IdentityTheft.gov, FTC report number [_______________].

E. No Authorization or Benefit

14. I did not provide my information to the perpetrator and did not authorize anyone to use my information.

15. I did not receive any goods, services, money, or other benefit from the fraudulent accounts or transactions.

16. I am not making this statement for any purpose unrelated to the identity theft.

F. Request for FCRA Block and Furnisher Action

17. Pursuant to 15 U.S.C. § 1681c-2, I request that each consumer-reporting agency receiving this affidavit block the fraudulent information identified in Section C from my credit file within four (4) business days of receipt.

18. Pursuant to 15 U.S.C. § 1681s-2 and 15 U.S.C. § 1681g(e), I request that each furnisher receiving this affidavit:

• Cease reporting the fraudulent information to all consumer-reporting agencies;
• Provide me with all application records, transaction records, and account documentation related to the fraudulent account(s) within 30 days; and
• Refrain from selling, transferring, or placing for collection any debt arising from the fraudulent account(s).

G. Penalty of Perjury

19. I declare under penalty of perjury under the laws of the State of Colorado and the United States that the foregoing is true and correct to the best of my knowledge and belief.

Executed on [__/__/____] at [CITY], Colorado.

[________________________________]

[VICTIM NAME] (Affiant)

ACKNOWLEDGMENT

State of Colorado, County of [_______________]

Subscribed and sworn to (or affirmed) before me this [____] day of [_______________], 20[____], by [VICTIM NAME], who proved to me on the basis of satisfactory evidence to be the person who appeared before me.

[________________________________]

Notary Public

My Commission Expires: [_______________]

(Notary Seal)

3. PART C — NOTIFICATION LETTERS TO CONSUMER-REPORTING AGENCIES

[VICTIM NAME]

[ADDRESS]

Date: [__/__/____]

VIA U.S.P.S. CERTIFIED MAIL — RETURN RECEIPT REQUESTED

[Equifax Information Services LLC, P.O. Box 105069, Atlanta, GA 30348-5069]

[OR Experian, P.O. Box 9554, Allen, TX 75013]

[OR TransUnion, P.O. Box 2000, Chester, PA 19016-2000]

Re: Identity Theft — Request for Block under 15 U.S.C. § 1681c-2

To Whom It May Concern:

I am a victim of identity theft. Pursuant to 15 U.S.C. § 1681c-2, I request that you block the fraudulent items identified on the enclosed credit report (circled) within four (4) business days of your receipt of this request.

I enclose the following:

• ☐ Sworn Identity Theft Affidavit (notarized);
• ☐ Police report from [AGENCY], case number [_______________];
• ☐ FTC Identity Theft Report from IdentityTheft.gov, report number [_______________];
• ☐ Copy of my Colorado driver's license / ID;
• ☐ Proof of current address (utility bill);
• ☐ A copy of my credit report with fraudulent items circled.

In addition, please:

1. Place an extended fraud alert on my file pursuant to 15 U.S.C. § 1681c-1(b) for seven (7) years;
2. Provide me with a free credit report at no cost;
3. Suppress my name from prescreened-offer lists for five (5) years per 15 U.S.C. § 1681b(e); and
4. Provide a written confirmation of all actions taken.

Sincerely,

[________________________________]

[VICTIM NAME]

4. PART D — NOTIFICATION LETTERS TO FURNISHERS

[VICTIM NAME]

[ADDRESS]

Date: [__/__/____]

VIA U.S.P.S. CERTIFIED MAIL — RETURN RECEIPT REQUESTED

[FURNISHER NAME — Fraud Department / Registered Agent]

[ADDRESS]

Re: Fraudulent Account / Reference No.: [_______________]

Identity Theft Notice and Demand under 15 U.S.C. § 1681s-2 and § 1681g(e)

To the Fraud Department:

I am a victim of identity theft. The account referenced above was opened or used without my authorization. I demand the following:

1. Cease furnishing. Do not furnish any information regarding this account to any consumer-reporting agency. 15 U.S.C. § 1681s-2(a)(6).

2. Investigate and correct. Conduct a reasonable investigation and correct or delete the fraudulent information. 15 U.S.C. § 1681s-2(b).

3. Provide records. Provide me, within 30 days, with copies of all application records, transaction records, signature cards, IP logs, and other documentation relating to this fraudulent account, pursuant to 15 U.S.C. § 1681g(e).

4. No collection or sale. Do not place this account for collection, sell or transfer it, or sue on it. C.R.S. § 5-16-107.

Enclosures: Sworn Identity Theft Affidavit; police report; FTC Identity Theft Report; copy of ID.

Sincerely,

[________________________________]

[VICTIM NAME]

5. COLORADO PRACTICE NOTES

• Colorado criminal statute. Identity theft under C.R.S. § 18-5-902 is a class 4 felony in most cases, escalating to class 3 felony where the victim is an at-risk adult. The Colorado Bureau of Investigation maintains a dedicated identity-theft unit.
• Police duty to take report. Under C.R.S. § 16-5-103(4), a person who knows or reasonably suspects unlawful use of identifying information may contact the local agency with jurisdiction over the person's residence or where the crime occurred. That agency must take a report, provide a copy, and begin investigating. If the suspected crime occurred elsewhere, it may refer the investigation to the agency there. Do not state that every Colorado agency has jurisdiction over every request.
• Civil remedy. C.R.S. § 13-21-127 provides a private right of action for identity-theft victims, including actual damages, costs, and reasonable attorney fees. The limitations period is generally three years from discovery.
• FCRA blocking timeline. Under 15 U.S.C. § 1681c-2(a), CRAs must block within 4 business days after receiving all four statutory items, subject to the section's exceptions. Under subsection (c), a CRA may decline or rescind after reasonably determining that the information was blocked or requested in error, the request or block rested on a relevant material misrepresentation, or the consumer obtained goods, services, or money from the blocked transaction.
• Free credit reports. Identity-theft victims are entitled to free credit reports beyond the standard annual entitlement, plus a free 12-month credit-monitoring after a fraud alert is placed. Use https://www.annualcreditreport.com.
• Security freeze. A Colorado consumer may request a security freeze under C.R.S. § 5-18-112. A consumer reporting agency may not charge for the first request to place the freeze under subsection (12)(b). This is separate from a fraud alert.
• Tax identity theft. If the affidavit covers IRS issues, also file IRS Form 14039 only if current IRS instructions call for it (Identity Theft Affidavit) and call the IRS identity and tax-return-status verification.
• Medical identity theft. HIPAA covered entities must provide an accounting of disclosures under 45 C.F.R. § 164.528. Send a written request.
• Data-breach origin. If the theft traces to a Colorado incident, determine whether a § 6-1-716 covered entity's good-faith investigation found misuse occurred or was reasonably likely, whether statutory notice was required, and whether the 30-day period from determination of a security breach was met. The section does not make every incident an automatic notice violation or create a private class claim by itself.
• Active-duty members. Service members may use an active-duty alert (15 U.S.C. § 1681c-1(c)) which lasts one year and suppresses prescreening for two.

6. SOURCES AND REFERENCES

• 15 U.S.C. § 1681a(q) — https://www.law.cornell.edu/uscode/text/15/1681a
• 15 U.S.C. § 1681c-2 (block) — https://www.law.cornell.edu/uscode/text/15/1681c-2
• 15 U.S.C. § 1681g(e) (records to victim) — https://www.law.cornell.edu/uscode/text/15/1681g
• 12 C.F.R. § 1022.3(i) — https://www.ecfr.gov/current/title-12/chapter-X/part-1022/section-1022.3
• C.R.S. § 16-5-103(4) — https://olls.info/crs/crs2025-title-16.htm
• C.R.S. § 18-5-902 — https://olls.info/crs/crs2026-title-18.htm
• C.R.S. § 18-5-904 — https://olls.info/crs/crs2026-title-18.htm
• C.R.S. § 13-21-127 — https://leg.colorado.gov/
• C.R.S. § 6-1-716 (data-breach notice) — https://leg.colorado.gov/
• FTC IdentityTheft.gov — https://www.identitytheft.gov/
• Colorado AG Identity Theft Resources — https://coag.gov/resources/identity-theft/
• Colorado Bureau of Investigation — https://cbi.colorado.gov/
• IRS Form 14039 only if current IRS instructions call for it — https://www.irs.gov/identity-theft-fraud-scams/identity-theft-guide-for-individuals#form14039

Disclaimer: This template is provided for informational purposes only and does not constitute legal advice. An attorney licensed in Colorado should review and customize the affidavit before submission, particularly where civil litigation against furnishers, CRAs, or the original breach source is contemplated.