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. 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 affidavit and supporting documentation to formally report the crime and request an official written report and case number. An official, valid identity theft report—not a case number or private affidavit alone—is required for an FCRA identity-theft block under 15 U.S.C. §§ 1681a(q)(4) and 1681c-2.

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 the case number, understanding that an acknowledgment alone may not satisfy the FCRA definition of an identity theft report);
• ☐ 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 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. AFFIDAVIT OF IDENTITY THEFT

STATE OF NORTH DAKOTA

COUNTY OF [COUNTY]

I, [VICTIM NAME], state as follows based on my personal knowledge:

4.1. The facts stated here are within my personal knowledge and are true and correct. [IF SUBMITTED BY A REPRESENTATIVE, STATE THE REPRESENTATIVE'S NAME, CAPACITY, AND AUTHORITY.]

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(1)) 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 investigation of the reported identity theft. I understand that knowingly giving false information or a false report to law enforcement that may interfere with an investigation or materially mislead an officer may violate N.D.C.C. § 12.1-11-03.

4.8. I request that the receiving law-enforcement agency accept this affidavit as supporting documentation for an official report. For FCRA purposes, an "identity theft report" must be an official, valid report filed with an appropriate government agency and must expose a false filer to criminal penalties. See 15 U.S.C. § 1681a(q)(4).

[________________________________]

[VICTIM NAME] — Affiant

5. SCHEDULE OF FRAUDULENT ACCOUNTS AND TRANSACTIONS

Total Disputed Amount: $[TOTAL]

6. OPTIONAL NOTARIZATION

Complete this section only if the receiving law-enforcement agency, creditor, or other recipient requests a notarized affidavit.

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

Use Equifax's current fraud-alert portal or the current mailing instructions on its request form:

equifax.com/personal/credit-report-services/credit-fraud-alerts/

Experian

Use Experian's current fraud-alert and identity-theft instructions:

experian.com/help/fraud-alert/

TransUnion

Use TransUnion's current Credit Help page for its online, telephone, and mailing instructions:

transunion.com/credit-help

Each Furnisher / Creditor listed in § 5 — request:

• ☐ Closure of fraudulent account
• ☐ Removal from credit reports
• ☐ Cessation of furnishing of identified information reported as identity theft, unless the furnisher later knows or is informed that the information is correct (15 U.S.C. § 1681s-2(a)(6)(B))
• ☐ Application and business-transaction records under 15 U.S.C. § 1681g(e), using a written request with the identity and identity-theft verification the statute requires
• ☐ Records within 30 days after receipt of a qualifying § 1681g(e) request

North Dakota Attorney General — Consumer Protection Division

Office of Attorney General

Consumer Protection Division

1720 Burlington Drive, Suite C

Bismarck, ND 58504-7736

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

attorneygeneral.nd.gov/consumer-resources/

Federal Trade Commission

IdentityTheft.gov

Internal Revenue Service (if tax-related theft)

IRS Form 14039 only if current IRS instructions call for it — 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 if requested by the recipient
• ☐ Requested an initial 1-year fraud alert from a nationwide CRA, which must refer the alert to the other nationwide CRAs (15 U.S.C. § 1681c-1(a))
• ☐ 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 (IRS Form 14039 only if current IRS instructions call for it) if tax-return theft suspected
• ☐ Notified SSA if Social Security number misused
• ☐ Notified North Dakota AG via attorneygeneral.nd.gov
• ☐ Considered contacting the ND Department of Financial Institutions if a regulated financial institution is involved
• ☐ 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 follow-up dates based on each recipient's current instructions and the applicable federal deadline

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(2), unauthorized use to obtain credit, money, goods, services, or another thing of value is a class B felony when the value exceeds $1,000 and otherwise a class C felony; a second or subsequent offense is a class A felony. Under subsection (3), specified unauthorized uses are a class A misdemeanor for a first offense and a class C felony for a second or subsequent offense, regardless of actual economic loss.
• Data-breach notification. Under N.D.C.C. § 51-30-02, a person that owns or licenses computerized data must notify a North Dakota resident whose unencrypted personal information was, or is reasonably believed to have been, acquired by an unauthorized person. Notice must be made in the most expedient time possible and without unreasonable delay, subject to the statute's investigation, system-restoration, and law-enforcement provisions. A breach exceeding 250 individuals also must be disclosed to the Attorney General. Section 51-30-07 treats a ch. 51-30 violation as a ch. 51-15 violation, and § 51-15-11 authorizes a civil penalty up to $5,000 per violation.
• Exemplary damages are not an independent claim. N.D.C.C. § 32-03.2-11 governs exemplary damages for a supported noncontract claim involving oppression, fraud, or malice. The initial complaint may not request exemplary damages; a later motion must include the statute's required factual support. Permission to amend uses a preponderance-based sufficiency inquiry, while an eventual award requires clear and convincing evidence.
• Security freezes and fraud alerts. Current federal law requires free security-freeze placement and removal. An initial fraud alert lasts at least one year; a qualifying identity-theft report supports a seven-year extended alert. N.D.C.C. ch. 51-33 separately governs North Dakota consumer credit report security freezes.
• FCRA blocking. Under 15 U.S.C. § 1681c-2, a CRA generally must block identified identity-theft information within four business days after receiving proof of identity, an identity theft report, identification of the information, and the consumer's statement that the information does not relate to the consumer's transaction. Section 1681a(q)(4) defines the required report as an official, valid report filed with an appropriate government agency; a private affidavit alone is not enough.
• Limitations. N.D.C.C. § 12.1-23-11(5) specifically requires a prosecution under that section to begin within six years after the victim discovers the facts constituting the violation. A civil fraud claim is generally subject to the six-year, discovery-accrual rule in N.D.C.C. § 28-01-16(6), but other claims may have different periods.
• Coordination with the AG. The North Dakota Attorney General's Consumer Protection Division lists (701) 328-3404 and (800) 472-2600 (in-state only), with division correspondence directed to 1720 Burlington Drive, Suite C, Bismarck, ND 58504-7736.

10. SOURCES AND REFERENCES

• N.D.C.C. ch. 12.1-23 (Theft and related offenses) — https://ndlegis.gov/cencode/t12-1c23.pdf
• N.D.C.C. ch. 12.1-11 (Perjury, false statements, and false reports) — https://ndlegis.gov/cencode/t12-1c11.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. ch. 51-33 (Consumer Credit Report Security Freezes) — https://ndlegis.gov/cencode/t51c33.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. § 1681a(q)(4) (identity theft report) — https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title15-section1681a&num=0&edition=prelim
• 15 U.S.C. § 1681c-2 (FCRA blocking) — https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title15-section1681c-2&num=0&edition=prelim
• 15 U.S.C. § 1681c-1 (FCRA fraud alerts and security freezes) — https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title15-section1681c-1&num=0&edition=prelim
• 15 U.S.C. § 1681g(e) (account records to victims) — https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title15-section1681g&num=0&edition=prelim
• 15 U.S.C. § 1681s-2(a)(6) (furnisher duties on identity-theft information) — https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title15-section1681s-2&num=0&edition=prelim
• 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/

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.