Identity Theft Affidavit and Police Report Cover Letter (Kansas) - Preparation Worksheet

IDENTITY THEFT AFFIDAVIT AND POLICE-REPORT COVER PACKET — KANSAS

TABLE OF CONTENTS

1. Part A — Cover Letter to Law Enforcement
2. Part B — Sworn Identity Theft Affidavit
3. Part C — Schedule of Fraudulent Accounts and Transactions
4. Part D — Demand to Furnishers and Credit Bureaus (FCRA § 605B)
5. Part E — Notice to Suppliers Under Wayne Owen Act / KCPA
6. Part F — Document Inventory and Distribution List
7. Kansas Practice Notes
8. Sources and References

1. PART A — COVER LETTER TO LAW ENFORCEMENT

SEND VIA CERTIFIED MAIL OR HAND-DELIVER

[Date]

[NAME OF AGENCY — e.g., [CITY/COUNTY] Police Department / [COUNTY] Sheriff's Office / Kansas Bureau of Investigation]

Attn: Records / Identity Theft Unit

[ADDRESS]

[CITY], Kansas [ZIP]**

Re: Request for Identity Theft Police Report — K.S.A. § 21-6107

Dear Officer / Detective:

I, [FULL LEGAL NAME], a resident of [CITY, COUNTY], Kansas, am the victim of identity theft. I respectfully request that your agency take a report and provide me a certified copy of that report, including the report number, for use with credit bureaus, financial institutions, and the Kansas Attorney General's Consumer Protection Division.

Statutory authority: K.S.A. § 21-6107 makes identity theft a severity level 8 nonperson felony, and identity theft involving more than $100,000 in monetary loss a severity level 5 nonperson felony. Any federal referral requires a separate analysis: 18 U.S.C. § 1028 requires the applicable subsection (a) conduct and mental state plus a subsection (c) circumstance; § 1028A requires its own conduct and predicate-felony elements. A state identity-theft allegation alone does not establish either federal offense.

Federal Trade Commission report: I have already filed an identity theft report with the FTC at IdentityTheft.gov on [__/__/____], FTC Reference No. [___]. A copy is attached.

Summary of facts:

• [BRIEF NARRATIVE — Date discovered, how discovered, fraudulent accounts, financial harm.]

Documents enclosed:

• ☐ FTC Identity Theft Report (IdentityTheft.gov);
• ☐ Sworn Identity Theft Affidavit (Part B below);
• ☐ Schedule of fraudulent accounts and transactions (Part C);
• ☐ Copies of fraudulent account statements, collection letters, or correspondence;
• ☐ Government-issued photo identification.

Why an official report matters: The Fair Credit Reporting Act, 15 U.S.C. § 1681c-2, requires consumer reporting agencies to block information resulting from identity theft within four business days after receiving an "identity theft report" and the other required materials. Under 12 C.F.R. § 1022.3(i), an FTC Identity Theft Report created through IdentityTheft.gov or a sufficiently specific official police or other qualifying government-agency report may qualify; the FTC report and police report are not categorically both required.

I am available to provide additional information at your convenience. Please contact me at [PHONE] or [EMAIL].

Thank you for your assistance.

Sincerely,

[________________________________]

[FULL LEGAL NAME]

2. PART B — SWORN IDENTITY THEFT AFFIDAVIT

STATE OF KANSAS

COUNTY OF [_______________]

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

2.1. Identity of Affiant

2.2. Discovery of the Identity Theft

2.2.1. I first became aware of the identity theft on or about [__/__/____] through [describe — credit-monitoring alert, denial of credit, debt collector call, IRS notice, etc.].

2.2.2. To the best of my knowledge, the identity theft began on or about [__/__/____] and is ☐ ongoing ☐ believed to be concluded as of __/__/____.

2.2.3. I do not know / I believe I know the perpetrator's identity (circle one). If known: [Name, relationship, last known address].

2.3. Sworn Statements

I hereby swear and affirm:

• (a) I did not authorize, ratify, or benefit from any of the accounts, charges, applications, or transactions identified in Part C;
• (b) I have not received any goods, services, money, or other benefit from the fraudulent accounts;
• (c) I will fully cooperate with law enforcement in the prosecution of the person or persons responsible;
• (d) I will testify truthfully if called as a witness;
• (e) The information in this affidavit and its enclosures is true and correct to the best of my knowledge, information, and belief.

2.4. Authorization

I authorize the release of the following information to law enforcement, the Kansas Attorney General's Consumer Protection Division, the Federal Trade Commission, the consumer reporting agencies (Equifax, Experian, TransUnion), and any furnisher or financial institution receiving this affidavit, for the limited purpose of investigating and remedying the identity theft described above:

• ☐ Account histories, statements, applications, and signature cards;
• ☐ Surveillance recordings, photographs, and electronic logs;
• ☐ Internal fraud-investigation files;
• ☐ Police reports and witness statements.

2.5. Notarization

[________________________________]

[FULL LEGAL NAME], Affiant

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

[________________________________]

Notary Public, State of Kansas

(My Commission Expires: [_______________])

3. PART C — SCHEDULE OF FRAUDULENT ACCOUNTS AND TRANSACTIONS

Total alleged fraudulent obligations: $[___]

Categories of fraud (check all that apply):

• ☐ New-account fraud (credit card, loan, line of credit);
• ☐ Account takeover (existing account compromised);

• ☐ Tax-related identity theft (false return filed in my name) — reviewed the
  current IRS guide and attached IRS Form 14039
  only if its instructions call for it;

• ☐ Government-benefits identity theft (unemployment, SNAP, Social Security);

• ☐ Medical identity theft;
• ☐ Employment identity theft (false W-2 / wages reported);
• ☐ Utility / telecom account fraud;
• ☐ Driver's license / state ID fraud;
• ☐ Criminal identity theft (impersonation in arrest / citation);
• ☐ Synthetic identity (combination of real and fabricated data);
• ☐ Other: [___].

4. PART D — DEMAND TO FURNISHERS AND CREDIT BUREAUS (FCRA § 605B)

To: [Furnisher / Credit Reporting Agency Name]

Pursuant to 15 U.S.C. § 1681c-2 (FCRA § 605B) and 12 C.F.R. § 1022.3(i), I demand that you:

4.1. Block any and all information resulting from the identity theft set forth in Part C from my consumer file within four (4) business days of receipt of this packet;

4.2. Notify the furnisher(s) of the blocked information that the information may be the result of identity theft and that the information has been blocked, pursuant to 15 U.S.C. § 1681c-2(b);

4.3. Provide me, free of charge, with copies of all application and business transaction records related to the fraudulent accounts pursuant to 15 U.S.C. § 1681g(e), within thirty (30) days of receipt of this affidavit;

4.4. Cease any continued furnishing of information regarding the fraudulent accounts, as required of furnishers by 15 U.S.C. § 1681s-2(a)(6);

4.5. Confirm in writing within thirty (30) days of receipt that all of the above has been completed.

Enclosed identity theft report (12 C.F.R. § 1022.3(i)):

• ☐ FTC Identity Theft Report (IdentityTheft.gov), Reference No. [___];
• ☐ Police report from [Agency], Report No. [___];
• ☐ Sworn affidavit (Part B above);
• ☐ Government-issued photo ID;
• ☐ Proof of current address.

5. PART E — NOTICE TO SUPPLIERS UNDER WAYNE OWEN ACT / KCPA

To: [Supplier / Creditor Name]

5.1. Pursuant to the Wayne Owen Act, K.S.A. § 50-6,139, conduct prohibited by the Kansas criminal identity-theft statute, K.S.A. § 21-6107, is an unconscionable act under K.S.A. § 50-627. For that statutory claim, the person committing the prohibited conduct is deemed the supplier, the victim is deemed the consumer, and proof of a consumer transaction is not required. This section does not automatically make an innocent creditor's handling of a dispute an identity-theft violation.

5.2. You are now on written notice that the account or transaction(s) described in Part C is the result of identity theft and was not authorized by me.

5.3. Pursuant to K.S.A. §§ 50-7a01 to 50-7a04 (Kansas Data Breach Notification Act), if your records indicate that my personal information was acquired by an unauthorized person from your systems or vendors, you are required to investigate and notify me as soon as possible without unreasonable delay.

5.4. I demand that you:

• (a) Immediately cease collection on any obligations identified in Part C;
• (b) Withdraw or correct any consumer reporting agency tradeline associated with the fraudulent obligations;
• (c) Provide me with copies of all account-opening documents, signature cards, IP-address and device logs, and surveillance imagery related to the fraudulent obligations pursuant to 15 U.S.C. § 1681g(e);
• (d) Confirm in writing within thirty (30) days that the foregoing has been done.

5.5. A private KCPA remedy depends on an applicable violation and the requirements of K.S.A. § 50-634; K.S.A. § 50-636 permits a court-set civil penalty of up to $10,000 per violation. If a violation is committed against a protected consumer, K.S.A. § 50-677 permits an additional penalty of up to $10,000. "Protected consumer" is defined in K.S.A. § 50-676 and includes an elder person, disabled person, veteran, surviving spouse of a veteran, member of the armed forces, or an immediate family member of a member of the armed forces. K.S.A. § 50-6,139b is different: subsection (e) gives the Attorney General exclusive enforcement authority and creates no private cause of action.

6. PART F — DOCUMENT INVENTORY AND DISTRIBUTION LIST

7. KANSAS PRACTICE NOTES

• Police-report request. K.S.A. § 21-6107 defines and penalizes identity theft and identity fraud; it does not require a law-enforcement agency to take a report or give a victim a certified copy. Request a written or informational report under the agency's procedures, but do not represent that § 21-6107 creates a right to one.
• Security freeze. Kansas law (K.S.A. § 50-723) and federal law (15 U.S.C. § 1681c-1) both authorize a free security freeze. Place a freeze on Equifax, Experian, and TransUnion plus the specialty bureaus (NCTUE, ChexSystems, LexisNexis, SageStream).
• Wayne Owen Act overlay. K.S.A. § 50-6,139 treats conduct prohibited by § 21-6107 as an unconscionable KCPA act and supplies deemed supplier/consumer status. Section 50-6,139a authorizes Attorney General assistance to victims. Section 50-6,139b imposes reasonable security and disposal duties on holders of personal information, but subsection (e) reserves enforcement exclusively to the Attorney General and creates no private cause of action.
• Data breach notice. If the identity theft traces to a corporate data breach, K.S.A. § 50-7a02 requires the entity to notify Kansas residents "as soon as possible" without unreasonable delay. Failure to provide timely notice is enforced by the Kansas Attorney General.
• FCRA § 605B blocking. Under 12 C.F.R. § 1022.3(i), an FTC Identity Theft Report created through IdentityTheft.gov or a sufficiently specific official police or other qualifying government-agency report may qualify. The two reports are not categorically both required; include supporting identification and disputed-item information required by 15 U.S.C. § 1681c-2.

• IRS tax-related identity theft. Follow the current IRS guide. File
  IRS Form 14039
  only if its instructions call for it; the guide says not to file the form if
  it was already submitted through IdentityTheft.gov. Use the separate current
  IRS process to request an Identity Protection PIN.

• Limitations periods. The KCPA carries a three-year limitations period for actual-damages claims under K.S.A. § 60-512. The FCRA private-action period is two years from discovery, five years from the violation, under 15 U.S.C. § 1681p.

• Criminal restitution. If the perpetrator is prosecuted under K.S.A. § 21-6107, K.S.A. § 21-6604 and § 21-6607 authorize restitution. Cooperate with prosecutors; restitution does not preclude civil remedies under the KCPA.

8. SOURCES AND REFERENCES

• K.S.A. § 21-6107 (Identity theft / identity fraud) — https://www.ksrevisor.gov/statutes/chapters/ch21/021_061_0007.html
• K.S.A. § 50-6,139 (Wayne Owen Act) — https://www.ksrevisor.gov/statutes/chapters/ch50/050_006_0139.html
• K.S.A. § 50-6,139a (Attorney General victim assistance) — https://www.ksrevisor.gov/statutes/chapters/ch50/050_006_0139a.html
• K.S.A. § 50-6,139b (Personal-information security and disposal) — https://www.ksrevisor.gov/statutes/chapters/ch50/050_006_0139b.html
• K.S.A. § 50-7a01 et seq. (Kansas Data Breach Notification Act) — https://www.ksrevisor.gov/statutes/chapters/ch50/050_007a_0001.html
• K.S.A. § 50-723 (Security freeze) — https://www.ksrevisor.gov/statutes/chapters/ch50/050_007_0023.html
• 15 U.S.C. § 1681c-2 (FCRA § 605B) — https://www.law.cornell.edu/uscode/text/15/1681c-2
• 15 U.S.C. § 1681g(e) (Right to records) — https://www.law.cornell.edu/uscode/text/15/1681g
• 12 C.F.R. § 1022.3(i) (Definition of identity theft report) — https://www.ecfr.gov/current/title-12/chapter-X/part-1022/section-1022.3
• FTC Identity Theft Recovery Plan — https://www.identitytheft.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
• Kansas Attorney General — Identity Theft Resources — https://www.ag.ks.gov/divisions/public-protection/consumer-protection/your-identity
• Kansas Bureau of Investigation — https://www.kbi.ks.gov/

Disclaimer: This template is provided for informational purposes only and does not constitute legal advice. An attorney licensed in Kansas must review and customize this document before use. Laws, regulations, and agency procedures change frequently; verify all authorities and contact information before submission.