Identity Theft Affidavit and Police Report Cover - Nebraska

IDENTITY THEFT AFFIDAVIT AND POLICE REPORT COVER — NEBRASKA

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. Nebraska Practice Notes
10. Sources and References

1. COVER LETTER TO LAW ENFORCEMENT

FROM:

[VICTIM NAME]

[STREET ADDRESS]

[CITY, NE ZIP]

[PHONE]

[EMAIL]

DATE: [__/__/____]

TO:

[POLICE DEPARTMENT / SHERIFF'S OFFICE / NEBRASKA STATE PATROL]

Attn: Records / Identity Theft Unit

[STREET ADDRESS]

[CITY, NE ZIP]

Re: Request to File Identity Theft Report — Neb. Rev. Stat. § 28-639

Dear Officer / Records Custodian:

I am the victim of identity theft as defined by Neb. Rev. Stat. § 28-639. 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);
• ☐ Forward a copy to the Nebraska Attorney General's Consumer Protection 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 NEBRASKA

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 nineteen (19) 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, or other personal identifying information to open the accounts or initiate the transactions identified in § 5 below.

4.3. I did not receive any goods, services, money, 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]].

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 under Neb. Rev. Stat. § 28-907 or perjury under Neb. Rev. Stat. § 28-915.

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 Neb. Rev. Stat. § 28-639, the Fair Credit Reporting Act (15 U.S.C. § 1681 et seq.), and the Nebraska Financial Data Protection and Consumer Notification of Data Security Breach Act (Neb. Rev. Stat. § 87-801 et seq.).

[________________________________]

[VICTIM NAME] — Affiant

5. SCHEDULE OF FRAUDULENT ACCOUNTS AND TRANSACTIONS

Total Disputed Amount: $[TOTAL]

6. NOTARIZATION

STATE OF NEBRASKA

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 Nebraska

(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

Nebraska Attorney General — Consumer Protection Division

Office of the Attorney General

Consumer Affairs Response Team

2115 State Capitol

Lincoln, NE 68509

(800) 727-6432 or (402) 471-2682

protectthegoodlife.nebraska.gov

[email protected]

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

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
• ☐ Placed 7-year extended fraud alert (requires identity-theft report)
• ☐ Placed security freeze with each CRA per Neb. Rev. Stat. § 8-2601 et seq.
• ☐ 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 Nebraska AG via protectthegoodlife.nebraska.gov
• ☐ Notified Nebraska Department of Banking and Finance if a financial-institution breach is suspected
• ☐ 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. NEBRASKA PRACTICE NOTES

• Statutory citation update. Nebraska's identity theft statute is now codified at Neb. Rev. Stat. § 28-639. The former § 28-608 was transferred in 2009 to § 28-638 (criminal impersonation). Identity fraud is § 28-640. Use the current sections in all law-enforcement and court filings.
• Penalty grading. Identity theft is graded by value gained or attempted: Class IIA felony ($5,000+); Class IV felony ($1,500–$4,999); Class I misdemeanor ($500–$1,499); Class II misdemeanor (less than $500 or no value). Restitution may be ordered under §§ 29-2280 to 29-2289.
• Prosecution limitations. A 5-year statute of limitations applies to identity-theft prosecutions under § 28-639.
• Civil restitution and damages. Nebraska courts may order restitution to victims as part of criminal sentencing. A separate civil action against the perpetrator (if identifiable and solvent) may seek actual damages and equitable relief, but NOT punitive damages (Neb. Const. art. VII, § 5; Distinctive Printing & Packaging Co. v. Cox, 232 Neb. 846 (1989)).
• Data-breach notification. If the theft arose from a financial institution or commercial entity breach, the entity has notification obligations under Neb. Rev. Stat. § 87-803, and the Attorney General must be notified.
• Security freeze. Nebraska's Credit Report Protection Act (Neb. Rev. Stat. § 8-2601 et seq.) authorizes free security freezes for all consumers and additional protections for identity-theft victims with a police report.
• 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 Nebraska affidavit and local police report together qualify.
• No punitive damages. Neither the criminal restitution award nor any companion civil action may include punitive damages under Nebraska law.

10. SOURCES AND REFERENCES

• Neb. Rev. Stat. § 28-639 (Identity theft) — https://nebraskalegislature.gov/laws/statutes.php?statute=28-639
• Neb. Rev. Stat. § 28-640 (Identity fraud) — https://nebraskalegislature.gov/laws/statutes.php?statute=28-640
• Neb. Rev. Stat. § 28-638 (Criminal impersonation, formerly § 28-608) — https://nebraskalegislature.gov/laws/statutes.php?statute=28-638
• Neb. Rev. Stat. § 87-801 et seq. (Financial Data Protection and Consumer Notification of Data Security Breach Act) — https://nebraskalegislature.gov/laws/statutes.php?statute=87-801
• Neb. Rev. Stat. § 8-2601 et seq. (Credit Report Protection Act — security freeze) — https://nebraskalegislature.gov/laws/statutes.php?statute=8-2601
• Neb. Rev. Stat. § 29-2280 et seq. (Restitution) — https://nebraskalegislature.gov/laws/statutes.php?statute=29-2280
• 15 U.S.C. § 1681c-2 (FCRA blocking) — https://www.law.cornell.edu/uscode/text/15/1681c-2
• 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/
• Nebraska AG — Identity Theft Resources — https://protectthegoodlife.nebraska.gov/
• Nebraska Department of Banking and Finance — Financial Data Protection — https://ndbf.nebraska.gov/about/legal/financial-data-protection-consumer-notification-data-security-breach-act-2006
• Nebraska DMV Identity Theft Packet — https://dmv.nebraska.gov/sites/dmv.nebraska.gov/files/doc/dvr/theftpacket.pdf

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