Identity Theft Affidavit and Police Report Cover Letter - North Carolina

IDENTITY THEFT AFFIDAVIT AND POLICE REPORT COVER PACKAGE — NORTH CAROLINA

TABLE OF CONTENTS

• Part A — Cover Letter to Law Enforcement
• Part B — Identity Theft Affidavit (sworn)
• Part C — FCRA § 605B Blocking Demand to Consumer Reporting Agency / Furnisher
• Part D — Security Freeze and Fraud Alert Reference
• North Carolina Practice Notes
• Sources and References

PART A — COVER LETTER TO LAW ENFORCEMENT

[DATE]

[LOCAL POLICE DEPARTMENT / SHERIFF'S OFFICE]

ATTN: Records Division / Identity Theft Unit

[ADDRESS]

[CITY], North Carolina [ZIP]

Re: Request to File Identity Theft Report — N.C. Gen. Stat. § 14-113.20

Victim: [VICTIM FULL LEGAL NAME]

DOB: [__/__/____] Last 4 of SSN: [____]

Dear Officer / Deputy:

I am the victim of identity theft, a felony under N.C. Gen. Stat. § 14-113.20. I respectfully request that you take this report and provide me with an incident number and a copy of the official report.

A signed Identity Theft Affidavit (Part B) is enclosed. I am also enclosing copies of supporting documents identifying the fraudulent accounts and transactions, including: [list — e.g., fraudulent credit-card statements, collection letters, denial letters, tradelines, bank-fraud letters].

The federal Fair Credit Reporting Act, 15 U.S.C. § 1681a(q), requires "an identity theft report" to trigger consumer reporting agency blocking obligations under 15 U.S.C. § 1681c-2 and extended fraud alerts under 15 U.S.C. § 1681c-1(b). A copy of an official police or sheriff's report — or, where applicable, a copy of an FTC IdentityTheft.gov Report — satisfies that requirement.

I request the following:

1. That an official report be created and an incident number assigned;
2. That I be provided a certified copy or, at minimum, a stamped copy reflecting filing date;
3. That the report identify each fraudulent account or transaction listed in the attached schedule; and
4. That the report be coded to indicate the matter as identity theft (NCIBRS code [____], if applicable).

I will cooperate fully with any investigation and am available at the contact information below.

Sincerely,

[________________________________]

[VICTIM FULL LEGAL NAME]

[STREET ADDRESS]

[CITY, NC ZIP]

Telephone: [_______________]

Email: [_______________]

Enclosures:

• Identity Theft Affidavit (Part B)
• Government-issued photo ID copy
• Schedule of fraudulent accounts/transactions
• Supporting documents (statements, letters, denials)

PART B — IDENTITY THEFT AFFIDAVIT (SWORN)

STATE OF NORTH CAROLINA

COUNTY OF [_______________]

I, [VICTIM FULL LEGAL NAME], being first duly sworn, depose and say:

1. I am a citizen and resident of [COUNTY] County, North Carolina, and the victim of identity theft as defined in N.C. Gen. Stat. § 14-113.20.

2. My identity:

3. I did not authorize, consent to, or benefit from the accounts, transactions, applications, or other activities listed in Schedule 1 attached. None of the listed transactions reflect any obligation of mine. I have not received any goods, services, monies, or other consideration as a result of those transactions.

4. Discovery. I first learned of the fraudulent activity on or about [DATE] through [describe — e.g., a denied credit application, a collection call, a credit report alert, a notice from financial institution].

5. No relationship. I do not know, and have never authorized, the perpetrator(s) to use my identifying information. [OR, if known: "I believe the perpetrator may be [NAME / RELATIONSHIP], who had access to [describe]."]

6. Steps taken. I have:

• ☐ Filed a report with [POLICE / SHERIFF] on [DATE], Report No. [__________];
• ☐ Filed an FTC IdentityTheft.gov Report on [DATE], Report No. [__________];
• ☐ Placed a fraud alert with [Equifax / Experian / TransUnion] on [DATE];
• ☐ Placed a security freeze under N.C. Gen. Stat. § 75-63 with all three nationwide consumer reporting agencies;
• ☐ Notified the affected financial institutions and creditors in writing;
• ☐ Filed IRS Form 14039 (if tax-related);
• ☐ Notified the Social Security Administration (if SSN misuse);
• ☐ Reported to the North Carolina Attorney General Consumer Protection Division;
• ☐ Other: [describe].

7. Schedule of fraudulent items. Schedule 1, attached, lists each known fraudulent account, transaction, or inquiry, together with creditor / merchant, date, amount, and current status.

8. Cooperation. I declare my willingness to assist law enforcement, financial institutions, and consumer reporting agencies in any investigation of this identity theft. I authorize the recipients of this affidavit to share copies with law enforcement and with one another for purposes of investigating the theft and remediating its effects.

9. Affirmation under FCRA § 605B. Pursuant to 15 U.S.C. § 1681c-2(a), I affirm that the information identified in Schedule 1 is the result of identity theft and is not information relating to any transaction by me.

10. The foregoing is true and correct based on my personal knowledge, except as to those matters stated upon information and belief, and as to those I believe them to be true.

Date: [__/__/____]

[________________________________]

[VICTIM FULL LEGAL NAME]

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

[________________________________]

Notary Public

(My Commission Expires: [_______________])

Schedule 1 — Fraudulent Accounts, Transactions, and Inquiries

PART C — FCRA § 605B BLOCKING DEMAND TO CONSUMER REPORTING AGENCY / FURNISHER

[DATE]

Via Certified Mail, Return Receipt Requested

[NAME OF CRA OR FURNISHER]

[ATTN: IDENTITY THEFT / DISPUTE DEPARTMENT]

[ADDRESS]

Re: Demand for Block of Identity-Theft Information — 15 U.S.C. § 1681c-2 / § 1681s-2(a)(6)

Consumer: [VICTIM NAME], Last 4 SSN [____], DOB [__/__/____]

Dear Sir or Madam:

I am a victim of identity theft. Pursuant to 15 U.S.C. § 1681c-2 (consumer reporting agencies) and 15 U.S.C. § 1681s-2(a)(6) (furnishers), I demand that you block from any consumer report, and cease furnishing, the information identified in Schedule 1 of the enclosed Identity Theft Affidavit. I enclose:

1. Proof of identity — copy of government-issued photo ID and a utility bill at my current address;
2. Identity theft report — copy of police/sheriff report, [Report No.], dated [DATE], [and/or] FTC IdentityTheft.gov Report dated [DATE];
3. Identification of the information — Schedule 1 attached, listing each fraudulent tradeline, inquiry, or transaction; and
4. Statement — my sworn statement that the listed information does not relate to any transaction by me (Affidavit ¶ 9).

You must block the identified information no later than four (4) business days after receipt of this notice. See 15 U.S.C. § 1681c-2(a). You must promptly notify the furnisher of the block. See 15 U.S.C. § 1681c-2(b).

You are also instructed:

• Not to refurnish blocked information without my written authorization;
• To provide me, free of charge, with the information and copies of documents identified at 15 U.S.C. § 1681g(e), including applications, billing statements, and transaction records associated with the fraudulent accounts; and
• To preserve all records relating to the disputed items.

Failure to comply violates the FCRA and exposes you to actual damages, statutory damages, costs, and attorney fees under 15 U.S.C. §§ 1681n and 1681o, as well as North Carolina state-law liability under the N.C. Identity Theft Protection Act, N.C. Gen. Stat. §§ 75-60 to 75-66, and the UDTPA, N.C. Gen. Stat. § 75-1.1 (including treble damages under § 75-16, subject to Gray v. NCIUA).

Please direct all correspondence to me at the address below.

Sincerely,

[________________________________]

[VICTIM FULL LEGAL NAME]

[ADDRESS]

[CITY, NC ZIP]

[PHONE] [EMAIL]

Enclosures: Identity Theft Affidavit; Schedule 1; copy of government-issued ID; copy of police / FTC report.

PART D — SECURITY FREEZE AND FRAUD ALERT REFERENCE

Consumer Reporting Agency Contacts:

• Equifax — https://www.equifax.com/personal/credit-report-services/credit-freeze/ — P.O. Box 105788, Atlanta, GA 30348-5788
• Experian — https://www.experian.com/freeze/center.html — P.O. Box 9554, Allen, TX 75013
• TransUnion — https://www.transunion.com/credit-freeze — P.O. Box 160, Woodlyn, PA 19094

NORTH CAROLINA PRACTICE NOTES

• Criminal track. N.C. Gen. Stat. § 14-113.20 makes identity theft a Class G felony (Class F if elements are aggravated); § 14-113.20A criminalizes trafficking in stolen identities (Class E felony). Local district attorneys prosecute; the SBI may investigate complex cases.
• Civil track. N.C. Gen. Stat. § 1-539.2C provides a civil cause of action to identity-theft victims for actual damages, costs, and attorney fees against perpetrators. UDTPA per se claims may also lie under § 75-66 (violation of the Identity Theft Protection Act).
• Security freeze. § 75-63 entitles consumers to a no-fee freeze; victims who supply a police report or investigative report cannot be charged for placement, removal, or temporary lift. Lift requests must be honored within 15 minutes (electronic) or 3 business days (mail).
• Breach notification. § 75-65 requires businesses to notify affected NC consumers without unreasonable delay; willful violation is a per se § 75-1.1 violation actionable under § 75-16 (treble damages — proximate-cause limited per Gray v. NCIUA).
• FCRA blocking. 15 U.S.C. § 1681c-2 requires CRAs to block within four business days of a sufficient notice. Furnishers must cease re-reporting blocked information; § 1681s-2(a)(6) imposes parallel duties.
• IdentityTheft.gov. The FTC's IdentityTheft.gov form generates an "Identity Theft Report" that satisfies § 1681a(q) for many purposes; pair it with an actual police report for maximum leverage with creditors and CRAs.
• Tax fraud overlay. If federal tax return fraud is suspected, file IRS Form 14039 and request an Identity Protection PIN. State tax fraud — contact the N.C. Department of Revenue Identity Theft Unit.
• Driver's license / DMV. Notify N.C. DMV if the victim's license number was used; request a duplicate with a flag.

SOURCES AND REFERENCES

• 15 U.S.C. § 1681c-2 (Block) — https://www.law.cornell.edu/uscode/text/15/1681c-2
• 15 U.S.C. § 1681s-2 (Furnisher Duties) — https://www.law.cornell.edu/uscode/text/15/1681s-2
• N.C. Gen. Stat. § 14-113.20 — https://www.ncleg.gov/EnactedLegislation/Statutes/PDF/BySection/Chapter_14/GS_14-113.20.pdf
• N.C. Gen. Stat. §§ 75-60 to 75-66 (Identity Theft Protection Act) — https://www.ncleg.gov/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_75/Article_2A.html
• N.C. Gen. Stat. § 75-63 (security freeze)
• N.C. Gen. Stat. § 75-65 (security breach notification)
• N.C. Gen. Stat. § 1-539.2C (civil action)
• IdentityTheft.gov — https://www.identitytheft.gov/
• FTC Identity Theft Affidavit — https://www.identitytheft.gov/Assistant
• N.C. Department of Justice — Identity Theft — https://ncdoj.gov/protecting-consumers/protecting-your-identity/

Disclaimer: This template is provided for informational purposes only and does not constitute legal advice. An attorney licensed in North Carolina must review and customize this document before use.