Identity Theft Affidavit and Police Report Cover - North Dakota

IDENTITY THEFT AFFIDAVIT AND POLICE REPORT COVER — NORTH DAKOTA

TABLE OF CONTENTS

1. Cover Letter to Law Enforcement
2. Victim Information
3. Suspect Information (if known)
4. Sworn Affidavit of Identity Theft
5. Schedule of Fraudulent Accounts and Transactions
6. Notarization
7. Distribution List and FCRA Blocking Letter
8. Action Checklist
9. North Dakota Practice Notes
10. Sources and References

1. COVER LETTER TO LAW ENFORCEMENT

FROM:

[VICTIM NAME]

[STREET ADDRESS]

[CITY, ND ZIP]

[PHONE]

[EMAIL]

DATE: [__/__/____]

TO:

[POLICE DEPARTMENT / SHERIFF'S OFFICE / NORTH DAKOTA HIGHWAY PATROL — CRIMINAL INVESTIGATIONS]

Attn: Records / Identity Theft Unit

[STREET ADDRESS]

[CITY, ND ZIP]

Re: Request to File Identity Theft Report — N.D.C.C. § 12.1-23-11

Dear Officer / Records Custodian:

I am the victim of identity theft as defined by N.D.C.C. § 12.1-23-11 (Unauthorized use of personal identifying information). I am submitting this notarized affidavit and supporting documentation to formally report the crime, request a written police report, and obtain a case number for use with the credit bureaus and creditors as authorized by 15 U.S.C. § 1681c-2 (FCRA identity-theft block).

Please:

• ☐ Open a case and assign an incident number;
• ☐ Provide me with a copy of the official police report (or, if unavailable, a written acknowledgment letter on department letterhead with case number);
• ☐ Forward a copy to the North Dakota Attorney General's Consumer Protection and Antitrust Division if you deem appropriate;
• ☐ Contact me at the number above for any additional information.

I have attached: (a) this sworn affidavit; (b) a schedule of fraudulent accounts and transactions; (c) a copy of the FTC IdentityTheft.gov report (if filed); and (d) supporting documentation (statements, correspondence, photographs of altered IDs, etc.).

Sincerely,

[________________________________]

[VICTIM NAME]

2. VICTIM INFORMATION

3. SUSPECT INFORMATION (if known)

4. SWORN AFFIDAVIT OF IDENTITY THEFT

STATE OF NORTH DAKOTA

COUNTY OF [COUNTY]

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

4.1. I am over the age of eighteen (18) and competent to testify to the matters stated herein. The facts stated are within my personal knowledge and are true and correct.

4.2. I am the victim of identity theft. I did not authorize, consent to, or benefit from the use of my name, Social Security number, date of birth, financial-account information, driver's license information, health insurance information, digital signatures, or any other personal identifying information (as defined by N.D.C.C. § 12.1-23-11(2)) to open the accounts or initiate the transactions identified in § 5 below.

4.3. I did not receive any goods, services, money, credit, or other thing of value from any of the fraudulent accounts or transactions listed.

4.4. I first became aware of the identity theft on [__/__/____] when [DESCRIBE — e.g., I received a collection call about a debt I did not incur; I was denied credit; I received a credit-card statement for an account I did not open; I received a data-breach notification from [COMPANY] dated [DATE] under N.D.C.C. § 51-30-02].

4.5. [DESCRIBE THE IDENTITY THEFT IN NARRATIVE FORM — what was opened or used, in what name, when discovered, how discovered, what steps you have taken to date, who you have contacted, and any persons you suspect.]

4.6. I have not authorized any person to use my personal identifying information for any of the accounts or transactions listed in § 5. I do not know the person(s) who used my information and have no business or family relationship with them, except as disclosed in § 3 above.

4.7. I am willing to assist in the prosecution of the person(s) who committed the identity theft. I understand that knowingly making false statements in this affidavit may subject me to criminal prosecution for false reporting to a public servant under N.D.C.C. § 12.1-11-03 or perjury under N.D.C.C. § 12.1-11-01.

4.8. I request that this affidavit be accepted by the receiving law-enforcement agency, consumer reporting agencies, and creditors for all purposes authorized by N.D.C.C. § 12.1-23-11, the Fair Credit Reporting Act (15 U.S.C. § 1681 et seq.), the FTC's identity-theft regulations, and the North Dakota security-breach notification regime (N.D.C.C. ch. 51-30).

[________________________________]

[VICTIM NAME] — Affiant

5. SCHEDULE OF FRAUDULENT ACCOUNTS AND TRANSACTIONS

Total Disputed Amount: $[TOTAL]

6. NOTARIZATION

STATE OF NORTH DAKOTA

COUNTY OF [COUNTY]

Subscribed and sworn to (or affirmed) before me on this [____] day of [_______________], 20[____], by [VICTIM NAME], who is personally known to me or who has produced [FORM OF ID] as identification.

[________________________________]

Notary Public, State of North Dakota

(My Commission Expires: [_______________])

(Seal)

7. DISTRIBUTION LIST AND FCRA BLOCKING LETTER

Pursuant to 15 U.S.C. § 1681c-2, each consumer reporting agency that has received fraudulent information about the victim must block that information within four (4) business days of receiving:

• ☐ Appropriate proof of identity;
• ☐ A copy of an identity-theft report;
• ☐ Identification of the information to be blocked; and
• ☐ A statement that the information is not information relating to any transaction by the consumer.

A copy of this affidavit, together with the police report and supporting documentation, is being sent to:

Equifax

P.O. Box 105069

Atlanta, GA 30348-5069

equifax.com/personal/credit-report-services/identity-theft

Experian

P.O. Box 9554

Allen, TX 75013

experian.com/fraud

TransUnion

P.O. Box 2000

Chester, PA 19016-2000

transunion.com/credit-help

Each Furnisher / Creditor listed in § 5 — request:

• ☐ Closure of fraudulent account
• ☐ Removal from credit reports
• ☐ Account-level documentation (15 U.S.C. § 1681g(e))
• ☐ Confirmation in writing within 30 days

North Dakota Attorney General — Consumer Protection and Antitrust Division

Office of Attorney General

Consumer Protection and Antitrust Division

600 E. Boulevard Avenue, Dept. 125

Bismarck, ND 58505-0040

(701) 328-3404 / (800) 472-2600

[email protected]

attorneygeneral.nd.gov/consumer-resources/

Federal Trade Commission

IdentityTheft.gov

1-877-IDTHEFT (1-877-438-4338)

Internal Revenue Service (if tax-related theft)

IRS Form 14039 — Identity Theft Affidavit

irs.gov/identity-theft-fraud-scams

Social Security Administration (if SSN misuse)

oig.ssa.gov/report

North Dakota Department of Transportation — Driver License Division (if NDDL misuse)

dot.nd.gov/divisions/driverslicense/

8. ACTION CHECKLIST

• ☐ Filed FTC report at IdentityTheft.gov (date: [__/__/____], report number: [________])
• ☐ Filed local police report (date: [__/__/____], report number: [________])
• ☐ Notarized this affidavit
• ☐ Placed initial 1-year fraud alert with all three nationwide CRAs (15 U.S.C. § 1681c-1)
• ☐ Placed 7-year extended fraud alert (requires identity-theft report)
• ☐ Placed security freeze with each CRA (free under federal law)
• ☐ Placed freeze with specialty CRAs (ChexSystems, LexisNexis, Innovis)
• ☐ Sent FCRA § 1681c-2 blocking demand to each CRA with required documents
• ☐ Sent dispute letters to each furnisher in § 5
• ☐ Requested account records from creditors under 15 U.S.C. § 1681g(e)
• ☐ Notified IRS (Form 14039) if tax-return theft suspected
• ☐ Notified SSA if Social Security number misused
• ☐ Notified North Dakota AG via attorneygeneral.nd.gov
• ☐ Notified ND Department of Financial Institutions if a financial-institution breach is suspected
• ☐ Verified that the breaching entity (if any) provided notice required by N.D.C.C. § 51-30-02
• ☐ Began contemporaneous log of all communications (date, time, person, channel)
• ☐ Retained copies of all submissions, certified-mail receipts, and return-receipt cards
• ☐ Calendared 30-day follow-up dates for each CRA and furnisher dispute

9. NORTH DAKOTA PRACTICE NOTES

• Criminal statute. North Dakota's identity-theft offense is N.D.C.C. § 12.1-23-11 (Unauthorized use of personal identifying information). The statute defines "personal identifying information" broadly and reaches conduct undertaken "regardless of whether there is any actual economic loss to the individual."
• Penalty grading. Under § 12.1-23-11, a first offense without economic loss is a class A misdemeanor; a second or subsequent offense is a class C felony. When the defendant obtains or uses information to obtain credit, money, goods, or services without authorization, the offense is a class B felony if the value exceeds $1,000, otherwise a class C felony, with a second or subsequent offense graded as a class A felony. Restitution may be ordered as part of sentencing.
• Data-breach notification. N.D.C.C. ch. 51-30 governs notification of security breaches involving personal information of North Dakota residents. The breaching entity must notify affected residents in the most expedient time possible, and must notify the Attorney General if more than 250 North Dakota residents are affected (N.D.C.C. § 51-30-02). Civil penalties of up to $5,000 per violation are available under § 51-30-07.
• Civil remedies. A separate civil action against the perpetrator (if identifiable and solvent) may seek actual damages and equitable relief. North Dakota also permits exemplary damages on a showing of oppression, fraud, or actual malice under N.D.C.C. § 32-03.2-11, but only after a court order on a prima facie evidentiary showing.
• NDCFA overlay. Where the perpetrator or a furnisher engaged in deceptive practices, a private NDCFA action under N.D.C.C. § 51-15-09 may yield treble damages and mandatory attorney's fees on a knowing violation.
• Security freeze. Under federal law, all consumers may place free security freezes with the three nationwide CRAs and lift them on request. North Dakota victims with a police report may also request 7-year extended fraud alerts.
• FCRA blocking. Under 15 U.S.C. § 1681c-2, CRAs must block identity-theft information within 4 business days of receiving a qualifying identity-theft report; the North Dakota notarized affidavit and local police report together qualify as an "identity theft report" under 15 U.S.C. § 1681a(q)(4).
• Limitations. The North Dakota statute of limitations for identity-theft prosecutions follows the general criminal statutes (N.D.C.C. § 29-04-02) — three years for misdemeanors and most felonies, longer for class AA and class A felonies. Civil claims for fraud or invasion of privacy carry a six-year limitations period under N.D.C.C. § 28-01-16.
• Coordination with the AG. The North Dakota Attorney General's Consumer Protection and Antitrust Division is the central state intake for identity-theft and data-breach complaints; (701) 328-3404 or (800) 472-2600.

10. SOURCES AND REFERENCES

• N.D.C.C. § 12.1-23-11 (Unauthorized use of personal identifying information) — https://codes.findlaw.com/nd/title-12-1-criminal-code/nd-cent-code-sect-12-1-23-11/
• N.D.C.C. ch. 12.1-23 (Theft and related offenses) — https://ndlegis.gov/cencode/t12-1c23.pdf
• N.D.C.C. ch. 51-30 (Notice of Security Breach for Personal Information) — https://ndlegis.gov/cencode/t51c30.pdf
• N.D.C.C. ch. 51-15 (Consumer Fraud / Unlawful Sales or Advertising Practices) — https://ndlegis.gov/cencode/t51c15.pdf
• N.D.C.C. § 32-03.2-11 (exemplary damages procedure) — https://ndlegis.gov/cencode/t32c03-2.pdf
• N.D.C.C. § 28-01-16 (six-year statute of limitations on civil actions) — https://ndlegis.gov/cencode/t28c01.pdf
• 15 U.S.C. § 1681c-2 (FCRA blocking) — https://www.law.cornell.edu/uscode/text/15/1681c-2
• 15 U.S.C. § 1681c-1 (FCRA fraud alerts and security freezes) — https://www.law.cornell.edu/uscode/text/15/1681c-1
• 15 U.S.C. § 1681g(e) (account records to victims) — https://www.law.cornell.edu/uscode/text/15/1681g
• FTC IdentityTheft.gov — https://www.identitytheft.gov/
• North Dakota Attorney General — Consumer Resources — https://attorneygeneral.nd.gov/consumer-resources/
• North Dakota Attorney General — Identity Theft Resources — https://attorneygeneral.nd.gov/consumer-resources/identity-theft/
• North Dakota Department of Financial Institutions — https://www.nd.gov/dfi/
• Perkins Coie ND Security Breach Chart — https://perkinscoie.com/insights/publication/security-breach-notification-chart-north-dakota

Disclaimer: This template is for informational purposes only and does not constitute legal advice. Identity theft has both criminal and civil dimensions; consult a North Dakota-licensed attorney for advice on civil remedies and prosecution coordination.