Identity Theft Affidavit and Police Report Cover (Illinois)

ILLINOIS IDENTITY THEFT AFFIDAVIT AND POLICE REPORT COVER

TABLE OF CONTENTS

1. Part A — Police Report Cover Letter
2. Part B — Identity Theft Affidavit
3. Part C — Distribution List and Mailing Instructions
4. Illinois Practice Notes
5. Sources and References

1. PART A — POLICE REPORT COVER LETTER

[CONSUMER FULL LEGAL NAME]

[STREET ADDRESS]

[CITY, IL ZIP]

[PHONE]

Date: [__/__/____]

[POLICE DEPARTMENT NAME]

Attn: Records / Identity Theft Unit

[STREET ADDRESS]

[CITY, IL ZIP]

RE: Request to File Identity-Theft Police Report — 720 ILCS 5/16-30

Dear Officer / Records Custodian:

I, [CONSUMER NAME], am the victim of identity theft as defined by 720 ILCS 5/16-30 (Illinois Identity Theft Law) and 18 U.S.C. § 1028. I respectfully request that the [DEPARTMENT NAME] take and file a written report documenting my victimization, and that I be provided a certified copy of that report.

A federal "Identity Theft Report" within the meaning of 15 U.S.C. § 1681a(q)(4) requires (a) a report alleging the identity theft filed with an appropriate federal, state, or local law-enforcement agency, and (b) a sworn statement detailing the alleged identity theft. Without an Identity Theft Report, consumer reporting agencies cannot apply the mandatory four-business-day block under 15 U.S.C. § 1681c-2, and I will be unable to clear my credit, financial, and personal records.

Attached are the following supporting materials:

☐ Sworn Identity Theft Affidavit (Part B below);

☐ Government photo identification: [Illinois driver's license / state ID / passport] No. [________________________________];

☐ Proof of residence: [utility bill / lease / mortgage statement] dated [__/__/____];

☐ Documentation of the identity theft (account statements, collection letters, credit reports, court papers, police communications): see itemized list at end of affidavit;

☐ Copy of FTC Identity Theft Report from IdentityTheft.gov, FTC Report Number [________________________________] (if filed).

I also request information regarding the Illinois Attorney General's Identity-Theft Passport Program (20 ILCS 2630/5.1) and any local victim-services referrals.

I am happy to be interviewed in person, by telephone, or by written statement at your convenience. Please contact me at [PHONE] or [EMAIL].

Sincerely,

[________________________________]

[CONSUMER NAME]

2. PART B — IDENTITY THEFT AFFIDAVIT

STATE OF ILLINOIS

COUNTY OF [COUNTY]

AFFIDAVIT OF IDENTITY THEFT

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

2.1. Identification of Affiant

1. My full legal name is [CONSUMER NAME].

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

3. The last four digits of my Social Security Number are [XXXX].

4. My current residence address is [STREET, CITY, IL ZIP], and I have resided there since [__/__/____].

5. My driver's license / Illinois state-ID number is [________________________________], issued by the Illinois Secretary of State.

2.2. Statement of Identity Theft

6. I am a victim of identity theft. On or about [__/__/____], or upon a continuing basis between [__/__/____] and [__/__/____], an unknown person or persons (the "Imposter") used my personal identifying information without my permission, knowledge, authorization, or consent.

7. I did not authorize, ratify, or benefit from any of the transactions, accounts, applications, or other conduct described in this affidavit.

8. I first discovered the identity theft on or about [__/__/____] when [DESCRIBE — e.g., I received a debt-collection letter; I obtained a credit report; my bank notified me of suspicious activity].

2.3. Specific Fraudulent Conduct

9. The Imposter used my personal identifying information to engage in the following conduct, each of which I dispute and disclaim:

10. [Add narrative for any non-account conduct: criminal impersonation, tax fraud, employment fraud, medical-identity theft, government-benefit fraud, etc.]

2.4. Disclaimer of Authorization

11. I did not apply for, open, authorize, sign, ratify, or use any of the accounts, transactions, applications, or charges identified in Paragraph 9.

12. I have not received goods, services, money, credit, or any other benefit from the conduct identified in Paragraph 9.

13. I have not given any person permission to use my name, Social Security number, date of birth, mailing address, or any other personal identifying information to obtain credit, goods, services, money, or any other benefit.

2.5. Identification of Suspects (if known)

14. [If applicable — e.g., I suspect that the Imposter is __, who is a __ (former roommate / employee / family member). The basis for that suspicion is __.] [Otherwise: I do not know the identity of the Imposter.]

2.6. Mitigation Steps Taken

15. I have taken the following steps to mitigate the identity theft:

☐ Filed a report with [POLICE DEPARTMENT] on [__/__/____], Report No. [________________________________];

☐ Filed an FTC Identity Theft Report at IdentityTheft.gov on [__/__/____], FTC Report No. [________________________________];

☐ Placed a fraud alert with the three nationwide consumer reporting agencies (Equifax, Experian, TransUnion) on [__/__/____];

☐ Placed a security freeze with the three nationwide consumer reporting agencies on [__/__/____];

☐ Notified affected financial institutions and creditors in writing on [__/__/____];

☐ Applied (or intend to apply) for an Illinois Identity-Theft Passport with the Illinois Attorney General pursuant to 20 ILCS 2630/5.1.

2.7. Requests Pursuant to Federal and Illinois Law

16. Pursuant to 15 U.S.C. § 1681c-2 (FCRA § 605B), I request that any consumer reporting agency receiving this affidavit, together with a copy of the police report, BLOCK all information arising from the identity theft within four business days of receipt.

17. Pursuant to 15 U.S.C. § 1681g(e), I request that any business that extended credit, opened an account, or executed a transaction in my name based on the identity theft provide me, free of charge, with copies of all application and business records relating to that transaction within 30 days.

18. Pursuant to 15 U.S.C. § 1681m(f), I demand that any debt collector contacted regarding identity-theft-related accounts cease collection activity immediately and notify the creditor.

19. Pursuant to 815 ILCS 530/ (Illinois Personal Information Protection Act), I request notice of any data breach involving my personal information that may underlie this identity theft.

20. I reserve all rights and remedies under federal and Illinois law, including under 720 ILCS 5/16-30, 815 ILCS 505/, 815 ILCS 530/, and the Fair Credit Reporting Act.

2.8. Verification

I declare under penalty of perjury under the laws of the State of Illinois that the foregoing statements are true and correct to the best of my knowledge and belief.

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

[________________________________]

[CONSUMER NAME], Affiant

Subscribed and sworn to before me this [____] day of [_______________], 20[____].

[________________________________]

Notary Public — State of Illinois

(My Commission Expires: [_______________])

3. PART C — DISTRIBUTION LIST AND MAILING INSTRUCTIONS

Send a complete copy of (a) this notarized affidavit, (b) the police report, and (c) supporting documentation to each of the following by USPS Certified Mail, Return Receipt Requested:

3.1. Nationwide Consumer Reporting Agencies (FCRA § 605B Block Request)

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

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

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

3.2. Furnishers and Creditors

☐ Each fraudulent-account furnisher listed in Paragraph 9 above (use the address on the most recent statement or collection letter).

3.3. Illinois Attorney General — Identity Theft Unit

☐ Illinois Attorney General — Identity Theft Hotline: (866) 999-5630; TTY: (877) 844-5461

☐ Online: https://illinoisattorneygeneral.gov/consumer-protection/identity-theft/

☐ Mail: Office of the Illinois Attorney General, Consumer Fraud Bureau, 100 W. Randolph St., Chicago, IL 60601

3.4. Federal Trade Commission

☐ Online: https://www.identitytheft.gov

☐ Phone: 1-877-IDTHEFT (1-877-438-4338)

3.5. Social Security Administration (if SSN misuse)

☐ SSA Fraud Hotline: 1-800-269-0271 — https://oig.ssa.gov/

3.6. Internal Revenue Service (if tax-related identity theft)

☐ Form 14039, Identity Theft Affidavit — https://www.irs.gov/forms-pubs/about-form-14039

4. ILLINOIS PRACTICE NOTES

• 720 ILCS 5/16-30 — Illinois Identity Theft Law. Defines identity theft as the knowing use of another's personal identifying information to obtain credit, money, goods, services, or other property, or to commit any felony. Aggravated identity theft (§ 16-30(b)) applies when the victim is 60 or older, disabled, in a declared emergency, or where the imposter uses the information in connection with another felony.
• 20 ILCS 2630/5.1 — Identity-Theft Passport. The Illinois Attorney General issues an Identity-Theft Passport to victims who have filed a police report. The passport can be presented to law-enforcement officers to prevent wrongful arrests, and to creditors as proof of victimhood. Apply through illinoisattorneygeneral.gov.
• 815 ILCS 530/ — Personal Information Protection Act (PIPA). Requires data collectors to notify Illinois residents of a breach of unencrypted personal information without unreasonable delay. Where the breach affects more than 500 Illinois residents, notice to the Attorney General is also required (815 ILCS 530/25). Identity-theft victims should request copies of any breach notice from suspected source-of-compromise entities.
• FCRA § 605B Block (15 U.S.C. § 1681c-2). A consumer reporting agency must block fraudulent information within four business days of receiving (a) appropriate proof of identity, (b) a copy of an Identity Theft Report, and (c) the consumer's identification of the information as fraudulent. The block remains in place permanently absent good cause.
• FCRA § 609(e) (15 U.S.C. § 1681g(e)). Allows the victim to obtain free copies of business records (account application, transaction records, signature cards) from any business that opened an account in the victim's name based on the theft, within 30 days of request.
• Police-report jurisdiction. Illinois police departments are obligated to take identity-theft reports from residents even when the underlying crime occurred outside the jurisdiction, pursuant to 5 ILCS 810/. If a department refuses, escalate to the Illinois State Police or the Illinois AG.
• FTC IdentityTheft.gov. Generates a personalized recovery plan and an FTC Identity Theft Report. A printed FTC report combined with a police report typically satisfies the FCRA "Identity Theft Report" definition. Some bureaus accept the FTC report alone; many do not. Best practice is to submit both.
• Statute of limitations preservation. Civil claims arising out of identity theft (e.g., FCRA, ICFA, common-law tort) carry their own limitations periods. Consider sending preservation letters early.
• Security freeze (no fee). Illinois consumers may place, lift, and remove a security freeze with each consumer reporting agency at no cost (15 U.S.C. § 1681c-1; 815 ILCS 505/2MM).

5. SOURCES AND REFERENCES

• 720 ILCS 5/16-30 (Illinois Identity Theft Law) — https://www.ilga.gov/legislation/ilcs/fulltext.asp?DocName=072000050K16-30
• 20 ILCS 2630/5.1 (Identity-Theft Passport) — https://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1900&ChapterID=5
• 815 ILCS 530/ (Personal Information Protection Act) — https://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=2702&ChapterID=67
• 15 U.S.C. § 1681c-2 (FCRA § 605B Block) — https://www.law.cornell.edu/uscode/text/15/1681c-2
• 15 U.S.C. § 1681g(e) (FCRA § 609(e) records) — https://www.law.cornell.edu/uscode/text/15/1681g
• 18 U.S.C. § 1028 (Federal Identity Theft) — https://www.law.cornell.edu/uscode/text/18/1028
• FTC IdentityTheft.gov — https://www.identitytheft.gov
• Illinois Attorney General — Identity Theft Resources — https://illinoisattorneygeneral.gov/consumer-protection/identity-theft/
• Illinois AG — Data Breach Reporting — https://illinoisattorneygeneral.gov/consumer-protection/for-businesses/data-breach/
• IRS Form 14039 — 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 Illinois must review and customize this document before use. Laws and regulations change frequently; verify all authorities before use.