Identity Theft Affidavit and Police Report Cover - Delaware

IDENTITY THEFT AFFIDAVIT AND POLICE REPORT COVER — DELAWARE

TABLE OF CONTENTS

1. Cover Sheet to Law Enforcement
2. Identification of Victim
3. Sworn Affidavit of Identity Theft
4. Schedule A — Fraudulent Accounts and Activity
5. Schedule B — Documents Provided
6. Request for Delaware Identity Theft Passport (11 Del. C. § 854A)
7. Demand for FCRA Block (15 U.S.C. § 1681c-2)
8. Furnisher Notice (15 U.S.C. § 1681s-2)
9. Notarization
10. Distribution List
11. Delaware Practice Notes
12. Sources and References

1. COVER SHEET TO LAW ENFORCEMENT

Date: [__/__/____]

To:

[NAME OF LAW ENFORCEMENT AGENCY]

Attn: Records / Fraud Unit

[STREET ADDRESS]

[CITY, DELAWARE ZIP]

Re: Identity Theft Report and Application for Delaware Identity Theft Passport pursuant to 11 Del. C. §§ 854 and 854A

To the Officer in Charge:

I, [YOUR NAME], am a victim of identity theft. I respectfully submit this packet for the purpose of (i) reporting the theft of my personal identifying information in violation of 11 Del. C. § 854; (ii) requesting issuance of a police-report case number and a copy of the official report; and (iii) initiating an application for a Delaware Identity Theft Passport under 11 Del. C. § 854A, which authorizes the Office of the Attorney General, in cooperation with this agency, to issue an identity theft passport to a victim of identity theft who has filed a police report.

This packet contains: (a) a sworn affidavit; (b) Schedule A listing fraudulent accounts and activity; (c) Schedule B listing supporting documents; (d) a demand for FCRA blocking; and (e) the consumer's contact information.

I respectfully request that this agency:

• ☐ Accept this report and assign a case number;
• ☐ Provide me a certified copy of the police report at no cost or at the standard fee;
• ☐ Forward a copy of the police report and the Identity Theft Passport application to the Delaware Office of the Attorney General, Fraud and Consumer Protection Division, Carvel State Building, 5th Floor, 820 N. French St., Wilmington, DE 19801, pursuant to 11 Del. C. § 854A.

2. IDENTIFICATION OF VICTIM

Full Legal Name: [________________________________]

Other Names Used: [________________________________]

Date of Birth: [__/__/____]

Last Four of SSN: [____]

Driver's License / State ID No.: [________________________________]

Current Address: [________________________________]

Address at Time of Theft (if different): [________________________________]

Phone: [________________________________]

Email: [________________________________]

Date Identity Theft First Discovered: [__/__/____]

Approximate Date Theft Began: [__/__/____]

Estimated Total Loss: $[AMOUNT]

3. SWORN AFFIDAVIT OF IDENTITY THEFT

STATE OF DELAWARE

COUNTY OF [NEW CASTLE / KENT / SUSSEX]

I, [YOUR NAME], being first duly sworn, depose and say:

3.1. I am over the age of 18 and competent to make this affidavit. The facts stated herein are true to the best of my personal knowledge.

3.2. I am a victim of identity theft as defined in 11 Del. C. § 854 and 16 C.F.R. § 603.3. Without my consent, an unknown person or persons obtained, used, or transferred my personal identifying information.

3.3. I did not authorize, ratify, benefit from, or participate in any of the transactions, accounts, or activity listed in Schedule A below. I have no business or familial relationship with the perpetrator(s).

3.4. I first discovered the identity theft on [__/__/____] when [DESCRIBE — e.g., I received a collection letter for an account I did not open / I reviewed my credit report / a creditor contacted me].

3.5. I have taken the following steps in response:

• ☐ Placed an initial fraud alert under 15 U.S.C. § 1681c-1 with [Equifax / Experian / TransUnion] on [__/__/____];
• ☐ Placed a security freeze on my consumer reports;
• ☐ Filed a complaint with the FTC at IdentityTheft.gov on [__/__/____] (Report Number: [________________________________]);
• ☐ Filed this police report with [AGENCY] on [__/__/____];
• ☐ Notified each affected creditor and furnisher in writing;
• ☐ Reviewed and disputed inaccurate items on each of my three nationwide credit reports;
• ☐ Changed passwords and PINs on legitimate accounts;
• ☐ Notified my financial institution(s) and requested account closure or replacement.

3.6. I understand that 11 Del. C. § 854 makes identity theft a Class D felony in Delaware and that knowingly making a false statement in this affidavit is a separate criminal offense.

3.7. I authorize the law enforcement agency to share this affidavit, the police report, and supporting documents with the Delaware Attorney General's Office, the Federal Trade Commission, the consumer reporting agencies, and any creditor or furnisher whose account is identified in Schedule A, for the sole purpose of investigation, blocking, and remediation.

[________________________________]

[YOUR FULL LEGAL NAME], Affiant

4. SCHEDULE A — FRAUDULENT ACCOUNTS AND ACTIVITY

5. SCHEDULE B — DOCUMENTS PROVIDED

• ☐ Government-issued photo ID
• ☐ Proof of address (utility bill, lease, mortgage statement)
• ☐ FTC Identity Theft Report from IdentityTheft.gov
• ☐ Tri-merge credit report or single-CRA reports with disputed items highlighted
• ☐ Dunning letters, billing statements, or other written notices from fraudulent creditors
• ☐ Bank statements showing unauthorized transactions
• ☐ Correspondence with creditors and CRAs to date
• ☐ [Other: __________________________________]

6. REQUEST FOR DELAWARE IDENTITY THEFT PASSPORT (11 Del. C. § 854A)

I hereby apply for a Delaware Identity Theft Passport pursuant to 11 Del. C. § 854A. I have filed a police report alleging that I am the victim of a violation of 11 Del. C. § 854. I request that the law enforcement agency taking this report transmit a copy of this application and the underlying police report to the Office of the Attorney General for processing.

I understand that:

• The application and supporting documents are confidential criminal-justice information and are exempt from disclosure under the Delaware Freedom of Information Act, Chapter 100 of Title 29.
• The Attorney General may issue an identity theft passport in the form of a card or certificate, which may include photo identification.
• The passport may be presented to law enforcement and creditors to help establish that I am the victim, not the perpetrator, of identity theft.

Applicant Signature: [________________________________]

Date: [__/__/____]

7. DEMAND FOR FCRA BLOCK (15 U.S.C. § 1681c-2)

To: [CONSUMER REPORTING AGENCY — Equifax / Experian / TransUnion]

Pursuant to 15 U.S.C. § 1681c-2, I hereby demand that you block from my consumer file all information that resulted from the identity theft identified in this report. This packet constitutes an "Identity Theft Report" as defined in 16 C.F.R. § 603.3 because it includes (i) the FTC Identity Theft Report (or this notarized affidavit), (ii) a copy of an official police report, and (iii) my identification of the information to be blocked.

You must block the disputed information no later than four (4) business days after receipt and notify the furnisher of the block.

Information to be blocked: see Schedule A.

8. FURNISHER NOTICE (15 U.S.C. § 1681s-2)

To: [FURNISHER NAME]

Pursuant to 15 U.S.C. § 1681s-2(a)(6), upon receipt of this Identity Theft Report you may not furnish information relating to the identified accounts to any consumer reporting agency unless and until you know or are informed by the consumer that the information is correct.

I demand that you (i) cease furnishing the disputed information to any CRA; (ii) close or remove the fraudulent account(s) from my name; (iii) provide me, free of charge, copies of all application records, transaction records, and signatures pertaining to the disputed accounts under 15 U.S.C. § 1681g(e); and (iv) confirm in writing within 30 days that you have complied.

9. NOTARIZATION

Sworn to and subscribed before me this [____] day of [_______________], 20[____].

[________________________________]

Notary Public — State of Delaware

My commission expires: [__/__/____]

(SEAL)

10. DISTRIBUTION LIST

• ☐ Local Delaware law enforcement agency that took the report
• ☐ Delaware Attorney General, Fraud and Consumer Protection Division — Carvel State Building, 5th Floor, 820 N. French St., Wilmington, DE 19801; (302) 577-8400 / (800) 220-5424; [email protected]
• ☐ Federal Trade Commission — IdentityTheft.gov; (877) 438-4338
• ☐ Equifax — P.O. Box 105069, Atlanta, GA 30348-5069
• ☐ Experian — P.O. Box 9554, Allen, TX 75013
• ☐ TransUnion — P.O. Box 2000, Chester, PA 19016
• ☐ Each furnisher / creditor identified in Schedule A
• ☐ Internal Revenue Service (IRS Form 14039) if tax-related identity theft
• ☐ Social Security Administration if SSN misuse
• ☐ U.S. Postal Inspection Service if mail-related fraud

11. DELAWARE PRACTICE NOTES

• Class D felony. 11 Del. C. § 854 makes identity theft a Class D felony in Delaware. Sentencing courts must order full restitution for monetary loss, including documented lost wages and reasonable attorney's fees, suffered by the victim.
• ID Theft Passport. Under 11 Del. C. § 854A, the Delaware Attorney General — in cooperation with any law enforcement agency that took the victim's report — may issue an identity theft passport. The application and supporting documents are confidential and exempt from FOIA. Implementing regulations are in the Delaware Administrative Code at 6 Del. Admin. C. § 101.
• Identity Theft Report definition. Under 16 C.F.R. § 603.3, an "Identity Theft Report" must (1) allege an identity theft, (2) be a copy of an official report filed with a federal, state, or local law enforcement agency, and (3) the filing of the report must subject the consumer to criminal penalties for false statements. This affidavit, combined with a Delaware police report, satisfies all three elements.
• FCRA blocking. A complete Identity Theft Report triggers the four-business-day blocking obligation under 15 U.S.C. § 1681c-2 and the furnisher cease-furnishing duty under 15 U.S.C. § 1681s-2(a)(6).
• Right to documents. Under 15 U.S.C. § 1681g(e), upon receipt of an Identity Theft Report, a business that opened the fraudulent account must, within 30 days, provide the victim free copies of the application and transaction records.
• Delaware breach notification. If theft was the result of a corporate data breach, see 6 Del. C. § 12B-101 et seq. for the notifying business's disclosure obligations.
• No fee for police report. Delaware law-enforcement agencies generally do not charge identity-theft victims for an initial report or a single certified copy.

12. SOURCES AND REFERENCES

• 11 Del. C. § 854 (Identity theft) — https://delcode.delaware.gov/title11/c005/sc03/index.html
• 11 Del. C. § 854A (Identity theft passport) — https://delcode.delaware.gov/title11/c005/sc03/index.html
• 6 Del. Admin. C. § 101 (Identity Theft Passports regulations) — https://regulations.delaware.gov/AdminCode/title6/Fraud/100/101.shtml
• 6 Del. C. ch. 12B (Computer Security Breaches) — https://delcode.delaware.gov/title6/c012b/index.html
• 15 U.S.C. § 1681 et seq. (FCRA) — https://www.law.cornell.edu/uscode/text/15/chapter-41/subchapter-III
• 16 C.F.R. § 603.3 (Identity Theft Report) — https://www.ecfr.gov/current/title-16/chapter-I/subchapter-F/part-603
• FTC IdentityTheft.gov — https://www.identitytheft.gov/
• Delaware AG Identity Theft — https://attorneygeneral.delaware.gov/identity-theft/
• Delaware AG Consumer Protection — https://attorneygeneral.delaware.gov/fraud/cpu/

Disclaimer: This template is provided for informational purposes only and does not constitute legal advice. Knowingly making a false statement in this affidavit is a criminal offense under Delaware law. A Delaware-licensed attorney should review this affidavit before submission.