Identity Theft Affidavit and Police Report Cover Letter - Florida

IDENTITY THEFT AFFIDAVIT AND POLICE REPORT COVER LETTER — FLORIDA

Florida provides significant identity theft protections, including the FDLE Compromised Identity Services program (an identity theft "passport" equivalent), mandatory law enforcement reporting, and severe criminal penalties under § 817.568. Florida's Identity Theft Victim Kit from the Attorney General's Office provides additional resources.

PART A: FTC IDENTITY THEFT REPORT INSTRUCTIONS

Step 1: File an FTC Identity Theft Report

The Federal Trade Commission (FTC) provides a centralized identity theft reporting system at IdentityTheft.gov.

Procedure:

1. Visit https://IdentityTheft.gov
2. Create an account (recommended) or proceed without one
3. Answer questions about the identity theft incident
4. Receive your Identity Theft Report and personalized recovery plan
5. Print and save the Identity Theft Report — you will need copies for creditors, CRAs, and law enforcement

Current IRS note: Form 14039 is an IRS tax-identity-theft form. Most
people do not need it. Use it only when the current IRS instructions direct
or permit filing:
https://www.irs.gov/identity-theft-fraud-scams/identity-theft-guide-for-individuals#form14039.

Step 2: Contact the Three Major Credit Reporting Agencies

Use the FTC current bureau directory at
https://consumer.ftc.gov/articles/credit-freezes-and-fraud-alerts. Verify each
bureau's current recipient, address, and submission channel immediately before
sending; do not rely on saved phone numbers or postal addresses.

Step 3: Place Fraud Alerts

Initial Fraud Alert (1 Year):

• Contact ONE CRA; that agency must notify the other two
• Lasts 1 year
• Requires creditors to take reasonable steps to verify identity before opening new accounts

Extended Fraud Alert (7 Years):

• Available to confirmed identity theft victims with an Identity Theft Report
• Lasts 7 years
• Requires creditors to contact the consumer directly before opening new accounts
• Consumer is removed from pre-screened credit offer lists for 5 years

Step 4: Place Security Freezes

Under federal law (Economic Growth, Regulatory Relief, and Consumer Protection Act of 2018), security freezes are free nationwide.

• Contact each of the three major CRAs individually
• CRA must place freeze within 1 business day (electronic) or 3 business days (mail)
• You will receive a unique PIN or password to lift or remove the freeze

Step 5: Florida-Specific — FDLE Compromised Identity Services

The Florida Department of Law Enforcement (FDLE) operates the Compromised Identity Services program, which functions as Florida's identity theft passport program:

• Purpose: Provides identity theft victims with a record in FDLE's system to help prevent wrongful arrest if the thief commits crimes using the victim's identity
• Eligibility: Florida residents who are victims of identity theft
• Application: Contact FDLE at (850) 410-7100 or visit fdle.state.fl.us
• Documentation Required: Police report, FTC Identity Theft Report, and government-issued ID

PART B: IDENTITY THEFT AFFIDAVIT

SECTION 1: VICTIM INFORMATION

Full Legal Name: [________________________________]

Former/Maiden/Other Names Used: [________________________________]

Date of Birth: [__/__/____]

Social Security Number: [____] - [____] - [____]

Current Address:

Street: [________________________________]

City: [________________________________] State: FL ZIP: [____]

How long at this address? [________________________________]

Previous Address (if at current address less than 2 years):

Street: [________________________________]

City: [________________________________] State: [____] ZIP: [____]

Home Phone: [________________________________]

Work Phone: [________________________________]

Cell Phone: [________________________________]

Email Address: [________________________________]

Florida Driver's License Number: [________________________________]

Florida ID Card Number (if applicable): [________________________________]

SECTION 2: FRAUDULENT ACCOUNT INFORMATION

Complete one entry for each fraudulent account. Attach additional pages if necessary.

Fraudulent Account #1

Fraudulent Account #2

Fraudulent Account #3

(Attach additional pages using the same format for additional fraudulent accounts.)

SECTION 3: HOW THE IDENTITY THEFT OCCURRED

How did you first discover the identity theft?

[________________________________]
[________________________________]
[________________________________]

When did the identity theft first occur (or your best estimate)? [__/__/____]

When did you first discover the identity theft? [__/__/____]

Do you know or suspect how the identity thief obtained your personal information?

☐ Lost or stolen wallet/purse
☐ Lost or stolen mail
☐ Data breach notification received (Company: [________________________________])
☐ Stolen from home, car, or office
☐ Someone I know had access to my information
☐ Phishing email or phone scam
☐ Online data compromise
☐ Medical or insurance records theft
☐ Tax-related identity theft
☐ Unknown
☐ Other: [________________________________]

SECTION 4: KNOWN OR SUSPECTED PERPETRATOR INFORMATION

Do you know or suspect who committed the identity theft?

☐ No — Skip to Section 5
☐ Yes — Complete below

Suspected Perpetrator's Name: [________________________________]

Relationship to Victim: [________________________________]

Last Known Address: [________________________________]

Phone Number: [________________________________]

Other Identifying Information: [________________________________]

Why do you suspect this person?

[________________________________]
[________________________________]

SECTION 5: TIMELINE OF EVENTS AND ACTIONS TAKEN

SECTION 6: ACTIONS ALREADY TAKEN

☐ Filed FTC Identity Theft Report at IdentityTheft.gov — Report Number: [________________________________]
☐ Filed police report — Agency: [________________________________] Report Number: [________________________________]
☐ Placed initial fraud alert (1-year) with: ☐ Equifax ☐ Experian ☐ TransUnion — Date: [__/__/____]
☐ Placed extended fraud alert (7-year) — Date: [__/__/____]
☐ Placed security freeze with: ☐ Equifax ☐ Experian ☐ TransUnion — Date: [__/__/____]
☐ Requested free credit reports from all three CRAs
☐ Contacted affected creditors/financial institutions
☐ Contacted debt collectors regarding fraudulent debts
☐ Applied to FDLE Compromised Identity Services program
☐ Filed complaint with Florida Attorney General (MyFloridaLegal.com)
☐ Contacted FLHSMV regarding driver license/ID fraud
☐ Filed IRS Identity Theft Affidavit (IRS Form 14039 only if current IRS instructions call for it) — if tax-related
☐ Contacted Social Security Administration — if SSN compromised
☐ Contacted U.S. Postal Inspection Service — if mail theft involved
☐ Changed passwords and PINs on all accounts
☐ Other: [________________________________]

SECTION 7: DECLARATION UNDER PENALTY OF PERJURY

I, [________________________________], declare under penalty of perjury under the laws of the United States and the State of Florida that the information provided in this affidavit is true and correct to the best of my knowledge. I understand that knowingly making false statements in this affidavit may subject me to criminal prosecution under 18 U.S.C. § 1001 (false statements to federal agencies) and Fla. Stat. § 837.02 (perjury).

I did not authorize any person to use my personal identifying information to open or access any of the accounts or conduct any of the transactions listed in this affidavit. I am willing to cooperate fully with any law enforcement agency, creditor, or credit reporting agency investigating this identity theft.

Signature: ________________________________________

Printed Name: [________________________________]

Date: [__/__/____]

NOTARIZATION BLOCK

STATE OF FLORIDA
COUNTY OF [________________________________]

Before me, the undersigned Notary Public, on this [____] day of [________________________________], 20[____], personally appeared [________________________________], who is personally known to me or who produced [________________________________] as identification, and who did take an oath and acknowledged before me that they executed the foregoing instrument for the purposes therein expressed.

WITNESS my hand and official seal.

Notary Public Signature: ________________________________________

Printed Name: [________________________________]

My Commission Expires: [__/__/____]

Commission Number: [________________________________]

Notary Seal/Stamp:

[SEAL]

Note: Florida Statutes § 117.05 governs notarial acts. Florida notaries must include their commission number and may use either "personally known to me" or identification-based verification.

PART C: POLICE REPORT COVER LETTER

[__/__/____]

[________________________________]
[________________________________]
[________________________________]
[________________________________]

Re: Request to File Identity Theft Police Report — Fla. Stat. § 817.568

Dear Officer/Detective:

I am writing to request that your department accept and file an identity theft report pursuant to Florida law. A sufficiently specific official police report may qualify under 15 U.S.C. § 1681a(q)(4) and 12 C.F.R. § 1022.3(i) for Fair Credit Reporting Act remedies; federal law does not categorically require a police report when the consumer has another qualifying government-agency report.

Florida Jurisdiction and Filing Rights

Under Florida law, an identity theft report may be filed with:

• The law enforcement agency in the city or county where the offense occurred, OR
• The law enforcement agency in the city or county where the victim resides

This dual-jurisdiction provision ensures that Florida identity theft victims can file a report locally, even if the fraud was committed in another location or online.

Background

My personal identifying information has been used without my authorization to open fraudulent accounts, make unauthorized transactions, and/or commit other fraudulent acts as detailed in the attached Identity Theft Affidavit. The total known fraudulent activity amounts to approximately $[________________________________].

Florida Criminal Law Provisions

Identity theft carries severe penalties in Florida:

Law Enforcement Surcharge

Upon conviction, the court must impose a $1,001 surcharge under § 817.568(7), with $500 deposited into the FDLE Operating Trust Fund for grants to local law enforcement to investigate identity theft offenses.

Information and Documents I Am Providing

☐ Completed Identity Theft Affidavit (attached)
☐ FTC Identity Theft Report (attached)
☐ Government-issued photo identification
☐ Proof of current address
☐ Credit reports showing fraudulent accounts (highlighted)
☐ Collection notices for fraudulent debts
☐ Correspondence from creditors regarding fraudulent accounts
☐ Documentation of financial losses
☐ Other supporting evidence: [________________________________]

Request

I respectfully request that you:

1. Accept this identity theft report and assign a case number
2. Provide me with a copy of the filed police report
3. Investigate the identity theft to the extent possible
4. Refer the matter to FDLE if the crime crossed jurisdictions or involves multiple victims

Respectfully,

Signature: ________________________________________

Printed Name: [________________________________]

Address: [________________________________]

Phone: [________________________________]

Email: [________________________________]

PART D: FLORIDA-SPECIFIC IDENTITY THEFT PROTECTIONS

FDLE Compromised Identity Services

The Florida Department of Law Enforcement operates the Compromised Identity Services program:

• Purpose: Maintains a record of verified identity theft victims in FDLE's database to help prevent wrongful arrest if the identity thief commits crimes using the victim's identity
• How to Apply: Contact FDLE at (850) 410-7100 or visit fdle.state.fl.us/Compromised-Identity-Services
• Required Documentation: Police report, FTC Identity Theft Report, government-issued ID
• Benefit: Law enforcement officers can verify the victim's identity against the FDLE database during encounters

Florida Attorney General Identity Theft Victim Kit

The Florida Attorney General publishes a comprehensive Identity Theft Victim Kit available at:

• Website: myfloridalegal.com/identity-theft
• Phone: (866) 966-7226

The kit includes step-by-step instructions, sample letters, and checklists specific to Florida residents.

Driver License and ID Fraud Protection

If your Florida driver's license or ID card has been compromised:

• Contact the Florida Department of Highway Safety and Motor Vehicles (FLHSMV)
• Phone: (850) 617-2000
• Website: flhsmv.gov/safety-center/consumer-education/fraud/identity-theft-driver-license-fraud/
• FLHSMV can place a fraud alert on your driver's license record and issue a new license number

Florida Information Protection Act (FIPA) — § 501.171

Florida's data breach notification law provides:

• Notification Deadline: Covered entities must notify affected individuals within 30 days of discovery of a breach (one of the shortest deadlines in the nation)
• Attorney General Notification: Required if more than 500 individuals are affected
• Covered Information: Social Security numbers, financial account numbers, driver's license numbers, medical information, health insurance information, email addresses with passwords
• Penalties: Up to $500,000 for failure to notify

Enhanced Penalties for Elder Victims

Florida provides enhanced penalties when identity theft victims are age 65 or older (§ 817.568(5)):

• The offense is reclassified one degree higher than it would otherwise be
• Example: A 3rd degree felony becomes a 2nd degree felony when the victim is an elder

Filing Complaints

Florida Attorney General — Consumer Protection Division
The Capitol PL-01
Tallahassee, FL 32399-1050
Phone: (866) 966-7226
Website: myfloridalegal.com

Florida Department of Agriculture and Consumer Services
Phone: (800) 435-7352
Website: fdacs.gov

FDLE — Compromised Identity Services
Phone: (850) 410-7100
Website: fdle.state.fl.us

PART E: SUPPORTING DOCUMENTATION CHECKLIST

Required Documents

☐ Completed Identity Theft Affidavit (Part B of this template)
☐ FTC Identity Theft Report from IdentityTheft.gov
☐ Police report with case number
☐ Government-issued photo identification
☐ Proof of current Florida address

Florida-Specific Documents

☐ FDLE Compromised Identity Services application/confirmation
☐ FLHSMV driver license fraud alert confirmation (if applicable)
☐ Florida Attorney General complaint confirmation

Credit-Related Documents

☐ Credit reports from all three CRAs with fraudulent items highlighted
☐ Fraud alert confirmation letters
☐ Security freeze confirmation letters/PINs
☐ Credit monitoring alerts

Fraudulent Account Documents

☐ Statements or notices for fraudulent accounts
☐ Collection letters for fraudulent debts
☐ Correspondence with creditors regarding disputes
☐ Denial letters for credit applications you did not make

Financial Impact Documents

☐ Bank statements showing unauthorized transactions
☐ Records of out-of-pocket expenses
☐ Records of lost wages or time spent resolving identity theft
☐ Documentation of denied credit, employment, or housing

Communication Records

☐ Log of all phone calls (date, time, person spoken to, reference numbers)
☐ Copies of all letters sent (with certified mail receipts)
☐ Email correspondence with creditors, CRAs, and law enforcement

PART F: RECIPIENT LIST — WHO TO SEND THE AFFIDAVIT TO

Use certified mail with return receipt requested for all mailings.

1. Credit Reporting Agencies (All Three)

2. Each Affected Creditor or Financial Institution

3. Debt Collectors

4. Florida Attorney General — Consumer Protection Division

5. FDLE Compromised Identity Services

6. Internal Revenue Service (If Tax-Related)

IRS identity and tax-return-status verification: 800-908-4490 (identity and tax-return-status verification only; not refund or other tax-account information)

7. Social Security Administration (If SSN Compromised)

Phone: 1-800-772-1213 | Report fraud: oig.ssa.gov

SOURCES AND REFERENCES

• Federal Trade Commission — IdentityTheft.gov: https://www.identitytheft.gov
• Fair Credit Reporting Act, 15 U.S.C. § 1681 et seq.: https://www.law.cornell.edu/uscode/text/15/chapter-41/subchapter-III
• Fla. Stat. § 817.568 (Criminal Use of Personal ID Info): https://www.flsenate.gov/laws/statutes/2024/817.568
• Fla. Stat. § 817.5685 (Unlawful Possession of Personal ID Info): https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0800-0899/0817/Sections/0817.5685.html
• Fla. Stat. § 501.171 (Florida Information Protection Act): https://www.flsenate.gov/Laws/Statutes/2024/501.171
• FDLE Compromised Identity Services: https://www.fdle.state.fl.us/Compromised-Identity-Services
• Florida Attorney General — Identity Theft: https://www.myfloridalegal.com/identity-theft
• Florida Identity Theft Victim Kit: https://www.myfloridalegal.com/identity-theft/identity-theft-victim-kit
• Consumer Financial Protection Bureau: https://www.consumerfinance.gov
• Annual Free Credit Reports: https://www.annualcreditreport.com

This template is provided for informational purposes only and does not constitute legal advice. Florida identity theft law provides significant criminal penalties and victim protections. Consult a qualified attorney licensed in Florida for advice specific to your situation.