Identity Theft Affidavit and Police Report Cover (Michigan)

IDENTITY THEFT AFFIDAVIT AND POLICE REPORT COVER LETTER (MICHIGAN)

TABLE OF CONTENTS

1. Cover Letter to Law Enforcement
2. Sworn Identity Theft Affidavit
3. Schedule A — Fraudulent Accounts and Transactions
4. Schedule B — Data-Breach Notifications Received
5. Schedule C — Supporting Documents Index
6. Notarization
7. Distribution Cover Page (CRAs and Creditors)
8. Michigan Practice Notes
9. Sources and References

1. COVER LETTER TO LAW ENFORCEMENT

[VICTIM FULL LEGAL NAME]

[STREET ADDRESS]

[CITY, MI ZIP]

[PHONE] • [EMAIL]

Date: [__/__/____]

[POLICE DEPARTMENT NAME — e.g., "Detroit Police Department" or "Michigan State Police, [POST NAME] Post"]

Attn: Records / Identity Theft Detective

[STREET ADDRESS]

[CITY, MI ZIP]

Re: Request to File Identity Theft Report — MCL §§ 445.65, 28.214(1)(a)(viii)

Dear Officer / Detective:

1.1. I am a victim of identity theft as defined by the Michigan Identity Theft Protection Act, MCL §§ 445.61–445.79d. I am writing to submit my sworn affidavit and to formally request that your agency accept and document this report pursuant to MCL § 28.214(1)(a)(viii), which requires Michigan law-enforcement agencies to take a report from a person who alleges that the person is a victim of identity theft.

1.2. Enclosed for your reference are:

• ☐ My sworn Identity Theft Affidavit (Section 2 below);
• ☐ Schedule A listing each fraudulent account or transaction known to me;
• ☐ Schedule B listing any data-breach notifications I have received;
• ☐ Schedule C indexing supporting documents;
• ☐ A copy of my government-issued photo identification;
• ☐ A copy of my FTC Identity Theft Report (IdentityTheft.gov), if obtained.

1.3. I respectfully request that your agency:

• ☐ Open a criminal investigation under MCL § 445.65 (Identity Theft) and any other applicable statutes;
• ☐ Provide me with a written police-report number and a copy of the report at no charge (MCL § 780.961 — victim rights to documents);
• ☐ Indicate on the report that I am a victim of identity theft so that the report may be used to block fraudulent information under 15 U.S.C. § 1681c-2.

1.4. I will fully cooperate with your investigation. Please contact me at the telephone number or email above with any questions or to schedule a follow-up interview.

Sincerely,

[________________________________]

[VICTIM NAME]

2. SWORN IDENTITY THEFT AFFIDAVIT

STATE OF MICHIGAN

COUNTY OF [COUNTY]

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

2.1. I am over the age of 18, am a resident of [CITY, COUNTY], Michigan, and have personal knowledge of the facts stated below.

2.2. Identity. My full legal name is [VICTIM NAME]. My date of birth is [__/__/____]. The last four digits of my Social Security number are [XXXX]. My current address is [CURRENT ADDRESS]. My address(es) for the prior five years were: [PRIOR ADDRESS(ES)].

2.3. Discovery of theft. On or about [__/__/____], I first discovered that I had become a victim of identity theft when [describe how discovery occurred — e.g., received a collection notice for an account I never opened; saw an unfamiliar account on my credit report; received a data-breach notice; was contacted by the IRS; etc.].

2.4. Authorization. I did NOT authorize any person to use my name, Social Security number, date of birth, financial-account numbers, driver's license number, or any other personal identifying information to open accounts, obtain credit, obtain goods or services, file tax returns, obtain government benefits, or for any other purpose, except for those accounts and transactions I personally initiated.

2.5. Suspect (if known). I [do / do not] know or suspect the identity of the perpetrator. [If known, identify by name and relationship; otherwise state "Identity of perpetrator is unknown to me."]

2.6. Fraudulent accounts and transactions. A complete list of all fraudulent accounts, charges, and transactions known to me as of the date of this affidavit is set forth in Schedule A and is incorporated herein by reference.

2.7. Data-breach notifications. A list of any data-breach notifications I have received under MCL § 445.72 (or analogous out-of-state law) that may relate to this theft is set forth in Schedule B.

2.8. No benefit received. I did not receive any money, goods, services, or other benefit from any of the fraudulent accounts or transactions identified in Schedule A.

2.9. Prior reports. I have [also reported / not yet reported] this identity theft to: [list — FTC IdentityTheft.gov on (DATE); Michigan AG on (DATE); IRS Identity Protection Specialized Unit on (DATE); Social Security Administration on (DATE); etc.].

2.10. Purpose of affidavit. I make this sworn statement (a) to support a criminal investigation under MCL § 445.65 and other applicable Michigan and federal law; (b) as an "identity theft report" within the meaning of 15 U.S.C. § 1681a(q)(4) for use in obtaining FCRA blocking under 15 U.S.C. § 1681c-2 and other CRA remedies; and (c) to support extended fraud alerts under 15 U.S.C. § 1681c-1(b).

2.11. I declare under penalty of perjury under the laws of the State of Michigan that the foregoing is true and correct.

[________________________________]

[VICTIM NAME]

3. SCHEDULE A — FRAUDULENT ACCOUNTS AND TRANSACTIONS

Total alleged fraudulent loss: $[______________]

4. SCHEDULE B — DATA-BREACH NOTIFICATIONS RECEIVED

5. SCHEDULE C — SUPPORTING DOCUMENTS INDEX

• ☐ Copy of government-issued photo ID (driver's license, state ID, or passport);
• ☐ Proof of current address (utility bill, lease, mortgage statement);
• ☐ Copies of credit reports from Equifax, Experian, and TransUnion showing fraudulent items;
• ☐ Collection letters / statements from each fraudulent account;
• ☐ Copies of any data-breach notification letters;
• ☐ FTC Identity Theft Report (IdentityTheft.gov);
• ☐ IRS Form 14039 (Identity Theft Affidavit), if tax-related;
• ☐ Any correspondence with creditors disputing the fraudulent accounts;
• ☐ Photographs, screenshots, or other evidence of the theft.

6. NOTARIZATION

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

[________________________________]

Notary Public, [COUNTY] County, Michigan

(My Commission Expires: [_______________])

7. DISTRIBUTION COVER PAGE (CRAs AND CREDITORS)

Date: [__/__/____]

To: [CREDITOR / CRA NAME]

[ADDRESS]

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

Tracking No. [________________________________]

Re: Identity Theft — Demand for FCRA Block / Account Closure / Document Production

7.1. I am a victim of identity theft. Enclosed is my notarized Identity Theft Affidavit, the police-report number issued by the [POLICE AGENCY] (Report No. [__________] dated [__/__/____]), and supporting documentation.

7.2. For Consumer Reporting Agencies (Equifax, Experian, TransUnion): Pursuant to 15 U.S.C. § 1681c-2, I demand that you BLOCK each item of information identified in Schedule A from my consumer file within FOUR (4) BUSINESS DAYS of receipt of this notice. I also request placement of an EXTENDED FRAUD ALERT under 15 U.S.C. § 1681c-1(b) for a period of seven (7) years.

7.3. For Creditors / Furnishers: Pursuant to 15 U.S.C. § 1681g(e), I demand that you provide me, at no charge and within thirty (30) days, copies of all application and business-transaction records relating to the fraudulent account(s) listed in Schedule A. I further demand that you (a) close each fraudulent account, (b) cease all collection activity, and (c) instruct each consumer reporting agency to delete the tradeline.

7.4. Continued reporting or collection of any fraudulent item after receipt of this notice may subject you to liability under the Fair Credit Reporting Act, 15 U.S.C. §§ 1681n and 1681o, and the Michigan Identity Theft Protection Act, MCL §§ 445.61 et seq.

Sincerely,

[________________________________]

[VICTIM NAME]

8. MICHIGAN PRACTICE NOTES

• Old § 750.285 repealed. The pre-2005 Michigan identity-theft criminal statute (MCL § 750.285) was repealed by 2004 PA 452 effective March 1, 2005, and replaced by the comprehensive Identity Theft Protection Act, MCL §§ 445.61–445.79d. Citing § 750.285 alone in a current pleading is incorrect — pair it (if at all) with § 445.65 and note the supersession.
• Penalty tiers under MCL § 445.65 / 445.69.
• First offense — felony, up to 5 years and/or $25,000;
• Second offense — up to 10 years and/or $50,000;
• Third or subsequent offense (or aggregated losses ≥ $20,000) — up to 15 years and/or $75,000.
• Mandatory police report. MCL § 28.214(1)(a)(viii) requires Michigan law-enforcement agencies to accept identity-theft reports. Insist on a written report number; that number is required to invoke FCRA blocking.
• Data breach overlay (MCL § 445.72). Entities that own or license computerized personal information of Michigan residents must notify residents and major CRAs (if breach affects 1,000+ residents) without unreasonable delay. Substitute notice (email + website + statewide media) is permitted in limited cases. Penalty for knowing failure: $250 per failed notice, $750,000 aggregate (MCL § 445.72a) — enforced by the AG.
• FCRA blocking standard. Under 15 U.S.C. § 1681c-2, a CRA must block within 4 business days of receipt of (i) appropriate proof of identity, (ii) a copy of an identity-theft report, (iii) the consumer's identification of the information, and (iv) a statement that the information is not the result of any transaction by the consumer.
• Extended fraud alerts. A consumer who submits an identity-theft report may obtain a 7-year extended fraud alert (15 U.S.C. § 1681c-1(b)), as compared to the 1-year initial alert.
• Free credit freeze. Michigan consumers (like all U.S. consumers post-Economic Growth Act of 2018) may place and lift credit freezes at all three CRAs free of charge.
• MI AG referral. The Michigan AG accepts identity-theft complaints through the Consumer Protection Division (P.O. Box 30213, Lansing, MI 48909; (517) 335-7622; toll-free (877) 765-8388).
• Do not destroy originals. Retain originals of every supporting document; submit copies only.

9. SOURCES AND REFERENCES

• MCL §§ 445.61–445.79d (Identity Theft Protection Act) — https://www.legislature.mi.gov/Laws/MCL?objectName=mcl-act-452-of-2004
• MCL § 445.65 (criminal identity theft) — https://www.legislature.mi.gov/Laws/MCL?objectName=mcl-445-65
• MCL § 445.72 (data-breach notification) — https://www.legislature.mi.gov/Laws/MCL?objectName=mcl-445-72
• MCL § 445.75 (repeal note for prior MCL § 750.285) — https://law.justia.com/codes/michigan/chapter-445/statute-act-452-of-2004/section-445-75/
• MCL § 28.214 (law-enforcement duty to take ID theft report) — https://www.legislature.mi.gov/
• 15 U.S.C. § 1681c-2 (FCRA blocking of identity-theft information) — https://www.law.cornell.edu/uscode/text/15/1681c-2
• 15 U.S.C. § 1681c-1 (fraud alerts) — https://www.law.cornell.edu/uscode/text/15/1681c-1
• 15 U.S.C. § 1681g(e) (right to documents) — https://www.law.cornell.edu/uscode/text/15/1681g
• FTC IdentityTheft.gov — https://www.identitytheft.gov/
• IRS Form 14039 (Identity Theft Affidavit) — https://www.irs.gov/forms-pubs/about-form-14039
• Michigan AG Consumer Protection — https://www.michigan.gov/ag/consumer-protection
• Michigan State Police — https://www.michigan.gov/msp

Disclaimer: This template is provided for informational purposes only and does not constitute legal advice. An attorney licensed in Michigan must review and customize this document before use. Laws, citations, and court rules change frequently; verify all authorities before use.