Identity Theft Affidavit and Police Report Cover Letter (Nevada) - Preparation Worksheet

IDENTITY THEFT AFFIDAVIT AND POLICE REPORT COVER PACKET — NEVADA

TABLE OF CONTENTS

1. Document A — Sworn Identity Theft Affidavit
2. Document B — Police Report Cover Letter
3. Document C — FCRA § 605B Block Demand to Credit Bureaus and Furnishers
4. Recipient Address Block
5. Mailing and Tracking Checklist
6. Nevada Practice Notes
7. Sources and References

1. DOCUMENT A — SWORN IDENTITY THEFT AFFIDAVIT

STATE OF NEVADA

COUNTY OF [COUNTY]

AFFIDAVIT OF [VICTIM FULL LEGAL NAME] IN SUPPORT OF IDENTITY THEFT CLAIM

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

A. Affiant Identification

1. I am over the age of eighteen (18) and competent to make this Affidavit. The facts stated herein are true of my own personal knowledge except as to those matters stated upon information and belief, and as to those, I believe them to be true.

2. My full legal name is [FULL LEGAL NAME]. My date of birth is [__/__/____]. The last four digits of my Social Security Number are xxx-xx-[____].

3. My current residential address is [STREET ADDRESS, CITY, NV ZIP], and I have resided in Nevada since [__/__/____].

4. My telephone number is [NUMBER] and my email address is [EMAIL].

B. Discovery of Identity Theft

5. On or about [__/__/____], I first learned that an unauthorized person had used my personal identifying information when [describe the discovery event — e.g., received a credit-card statement for an account I did not open / was denied credit / received an IRS notice / received a NRS 603A.220 data-breach notice from [DATA COLLECTOR]].

6. I have NOT authorized any person to use my name, Social Security Number, date of birth, driver's license, financial-account numbers, or any other personal identifying information ("PII") to open accounts, obtain credit, services, money, or property, or to engage in any transaction.

7. The conduct I have discovered constitutes "identity theft" as defined by NRS 205.4617 and an "unlawful use of personal identifying information" within the meaning of NRS 205.463.

C. Fraudulent Accounts, Charges, and Activity

8. I did not open, authorize, ratify, or benefit from any of the accounts or transactions listed above.

D. Suspected Source of the Identity Theft (Optional)

9. [If known] I believe the source of the unauthorized use was [describe — e.g., a data breach disclosed by [ENTITY] under NRS 603A.220 on [DATE]; a stolen wallet on [DATE]; a phishing email; a lost mailpiece; a known suspect [NAME, RELATIONSHIP]].

10. [If known] The suspected perpetrator is [NAME, ADDRESS, RELATIONSHIP, AGE]. I [do / do not] authorize prosecution.

E. Steps Already Taken

11. On [__/__/____], I filed an Identity Theft Report with the Federal Trade Commission at IdentityTheft.gov. The FTC Reference Number is [________________].

12. On [__/__/____], I placed an initial fraud alert (15 U.S.C. § 1681c-1(a)) and/or a security freeze (NRS 598C.300) with each of the three nationwide credit reporting agencies (Equifax, Experian, TransUnion).

13. On [__/__/____], I filed a police report with the [LAW ENFORCEMENT AGENCY] under Report Number [________________].

14. [Optional] I have notified the Social Security Administration's Office of the Inspector General at oig.ssa.gov and the Internal Revenue Service via IRS Form 14039 only if current IRS instructions call for it (Identity Theft Affidavit).

F. Authorization to Act on My Behalf

15. I authorize the recipient of this Affidavit (and any consumer reporting agency, financial institution, debt collector, or governmental entity to which it is presented) to:

(a) Block the disputed information under FCRA § 605B (15 U.S.C. § 1681c-2);

(b) Provide me, free of charge, with copies of the application, account-opening records, and transaction records relating to the fraudulent accounts pursuant to FCRA § 609(e) (15 U.S.C. § 1681g(e));

(c) Report the disputed accounts as DISPUTED and as resulting from identity theft to all consumer reporting agencies pursuant to 15 U.S.C. § 1681s-2.

G. Penalty of Perjury and Verification

16. I declare under penalty of perjury under the laws of the State of Nevada and under 28 U.S.C. § 1746 that the foregoing is true and correct.

Executed on this [____] day of [_______________], 20[____], in [CITY], [COUNTY] County, Nevada.

[________________________________]

[VICTIM SIGNATURE]

[VICTIM PRINTED NAME]

NOTARY ACKNOWLEDGMENT

STATE OF NEVADA

COUNTY OF [COUNTY]

Subscribed and sworn (or affirmed) before me on this [____] day of [_______________], 20[____], by [VICTIM NAME], proved to me on the basis of satisfactory evidence (☐ government-issued photo ID; ☐ credible witness) to be the person who appeared before me.

[________________________________]

Notary Public, State of Nevada

(My Commission Expires: [__/__/____])

(Notary Seal)

2. DOCUMENT B — POLICE REPORT COVER LETTER

[VICTIM NAME]

[STREET ADDRESS]

[CITY, NV ZIP]

[PHONE] | [EMAIL]

Date: [__/__/____]

[NAME OF NEVADA LAW ENFORCEMENT AGENCY]

Attn: Records / Identity Theft Unit

[STREET ADDRESS]

[CITY, NV ZIP]

Re: Request to File Identity Theft Police Report — Victim [VICTIM NAME]

To the Records / Identity Theft Unit:

I am the victim of identity theft. I respectfully request that your agency take and file a written police report of the identity theft I have suffered, and provide me with a copy of the report bearing an official report number.

A police report may support the following processes:

• Serve as a qualifying identity theft report for an FCRA § 605B block (15 U.S.C. § 1681c-2), if it meets 15 U.S.C. § 1681a(q)(4);
• Satisfy the police-report portion of the verification a business may require for a records request under FCRA § 609(e) (15 U.S.C. § 1681g(e)), together with a standardized or otherwise acceptable affidavit; and
• Establish my eligibility for restitution under NRS 205.4651 if a perpetrator is identified.

The conduct I have suffered is criminal under, at a minimum, NRS 205.463 (unlawful use of personal identifying information of another), which is a Category B felony when the loss exceeds $3,000, the victim is a vulnerable or older person, or the offender obtained the PII of five or more persons.

I enclose:

• ☐ My sworn Identity Theft Affidavit (Document A);
• ☐ My FTC Identity Theft Report (FTC Reference No. [________________]) from IdentityTheft.gov;
• ☐ Copies of fraudulent account statements / collection notices;
• ☐ Copy of my government-issued photo ID;
• ☐ Proof of my Nevada residence (utility bill / lease / mortgage statement); and
• ☐ A list of accounts and transactions I dispute.

I respectfully request that the report be assigned to your identity-theft / financial-crimes unit and that I be notified of any investigative developments. Please provide a certified copy of the report at your earliest convenience.

Thank you for your assistance.

Respectfully,

[________________________________]

[VICTIM NAME]

Enclosures as noted

3. DOCUMENT C — FCRA § 605B BLOCK DEMAND TO CREDIT BUREAUS AND FURNISHERS

[VICTIM NAME]

[STREET ADDRESS]

[CITY, NV ZIP]

[PHONE] | [EMAIL]

Date: [__/__/____]

[CREDIT BUREAU OR FURNISHER NAME]

Attn: Identity Theft / Disputes Department

[STREET ADDRESS]

[CITY, STATE ZIP]

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

USPS Tracking No.: [________________]

Re: Identity Theft Block Request — Consumer [VICTIM NAME], SSN ending [xxxx]

To Whom It May Concern:

I am the victim of identity theft. Pursuant to Section 605B of the Fair Credit Reporting Act, 15 U.S.C. § 1681c-2, I demand that you BLOCK the reporting of all information identified below that resulted from the alleged identity theft within four (4) business days of your receipt of this letter.

A. Information to Be Blocked

B. Documents Enclosed (Required by 15 U.S.C. § 1681c-2(a))

• ☐ Proof of identity (government-issued photo ID + proof of address);
• ☐ A copy of an Identity Theft Report (FTC Identity Theft Report, FTC Reference No. [________________], AND/OR police report from [AGENCY], Report No. [________________]);
• ☐ Sworn Identity Theft Affidavit (Document A);
• ☐ Identification of the information to be blocked (above table); and
• ☐ A statement that the information is not information relating to any transaction by me.

C. Furnisher-Specific Demands (15 U.S.C. §§ 1681s-2, 1681g(e))

If you are a FURNISHER (rather than a credit reporting agency), you are additionally directed to:

1. Cease furnishing the disputed information to any consumer reporting agency (15 U.S.C. § 1681s-2(a)(6)(B));

2. Within 30 days, provide me, free of charge, with copies of the application and business transaction records relating to the disputed account(s) (15 U.S.C. § 1681g(e)). Mail to my address above; do not telephone, email, or text;

3. Notify any subsequent assignee, debt buyer, or collection agent that the account is the product of identity theft.

D. Nevada-Specific Notice

The conduct giving rise to the disputed information is criminal under NRS 205.463 and may also implicate other law. Remedies depend on the duty allegedly violated. Sections 1681n and 1681o expressly do not apply to a violation of § 1681g(e), except as provided in § 1681s.

E. Preservation Demand

I direct you to preserve, and not to destroy, alter, or modify, any documents, records, electronically stored information, call recordings, or other materials relating to the disputed information or to your handling of this dispute, including audit logs of any future modifications.

I request written confirmation of the block within fifteen (15) days. Please direct all correspondence to the address above.

Respectfully,

[________________________________]

[VICTIM NAME]

Enclosures as noted

4. RECIPIENT ADDRESS BLOCK

Nationwide Credit Reporting Agencies (Identity Theft Block addresses)

• Equifax Information Services LLC — P.O. Box 105069, Atlanta, GA 30348-5069
• Experian — P.O. Box 9554, Allen, TX 75013
• TransUnion LLC — Fraud Victim Assistance Department, P.O. Box 2000, Chester, PA 19016-2000

Nevada Law Enforcement (Sample Agencies — Use the Agency for the Victim's Jurisdiction)

• Las Vegas Metropolitan Police Department — Records Bureau, 400 S. Martin Luther King Blvd., Las Vegas, NV 89106
• Reno Police Department — 455 E. Second St., Reno, NV 89502
• Henderson Police Department — 223 Lead St., Henderson, NV 89015
• Washoe County Sheriff's Office — 911 Parr Blvd., Reno, NV 89512

Nevada State Resources

• Nevada Attorney General — Bureau of Consumer Protection — 100 N. Carson St., Carson City, NV 89701; (775) 684-1100; https://ag.nv.gov/
• Nevada Financial Institutions Division — 3300 W. Sahara Ave., Suite 250, Las Vegas, NV 89102; https://fid.nv.gov/

5. MAILING AND TRACKING CHECKLIST

☐ FTC Identity Theft Report filed at IdentityTheft.gov; reference number recorded.

☐ Police report filed with appropriate Nevada agency; report number recorded.

☐ Affidavit (Document A) signed and notarized.

☐ Three Document C packets prepared — one for each nationwide credit bureau.

☐ One Document C packet prepared for each individual furnisher of disputed information.

☐ All packets mailed by U.S. Certified Mail, Return Receipt Requested; tracking numbers logged.

☐ Calendar set: 4 business days for bureau block under FCRA § 605B; 15 days for written confirmation; 30 days for furnisher records under FCRA § 609(e).

☐ Security freezes placed at all three bureaus (NRS 598C.300; free under federal law since 2018).

☐ Current IRS guide reviewed; IRS Form 14039
filed only if its instructions call for it.

☐ Social Security Administration OIG notified at oig.ssa.gov if SSN-related.

☐ Bank and existing-creditor accounts reviewed for unauthorized activity; new account numbers requested as needed.

6. NEVADA PRACTICE NOTES

• NRS 205.463 grading. Identity theft in Nevada is a Category B felony where (i) the loss exceeds $3,000, (ii) the victim is a vulnerable or older person, or (iii) the offender obtained PII of five or more persons; otherwise generally a Category C felony. Penalties include up to 20 years' imprisonment and a $100,000 fine, plus mandatory restitution under NRS 205.4651.
• Mandatory restitution. NRS 205.4651 directs courts to order restitution to identity-theft victims, including reasonable attorney's fees, costs of repairing credit history and rating, and amounts of debts or liens incurred by the victim.
• Data-breach origin. If the identity theft traces to a NRS 603A.220 data-breach notification, preserve the breach letter. The data collector's failure to implement reasonable security under NRS 603A.210 and timely notify under 603A.220 can support a separate NRS 41.600 / NDTPA action and class claims.
• FCRA § 605B four-day block. Credit bureaus must block within four BUSINESS days of receiving a complete identity-theft report. The block survives indefinitely unless the bureau finds the report is materially false or the consumer obtained possession of goods/services as a result of the blocked transaction (15 U.S.C. § 1681c-2(c)).
• FCRA § 609(e) business records. A covered business generally must provide without charge, within 30 days after a qualifying written victim request, the application and business-transaction records in its control that evidence the alleged identity-theft transaction. Apply the statute's identity-and-claim verification, address, transaction-detail, refusal, record-availability, and other-law limits; furnisher status alone does not trigger the duty.
• Fraud alerts vs. security freezes. A fraud alert (15 U.S.C. § 1681c-1) lasts one year (initial), seven years (extended for documented victims), or one year (active-duty military). A security freeze (NRS 598C.300; 15 U.S.C. § 1681c-1(i)) is more protective and is now free under federal law for both placement and removal.
• Statute of limitations on civil identity-theft claims. Tort claims in Nevada are generally two years (NRS 11.190(4)(e)); statutory consumer-fraud actions under NRS 41.600 are typically three years under NRS 11.190(2)(d). FCRA actions: two years from discovery, with a five-year cap (15 U.S.C. § 1681p).
• One-party recording rule. Nevada is generally a one-party-consent state for telephone-call recording. Recordings of calls with creditors or collectors regarding the disputed accounts are admissible and can corroborate the affidavit.

7. SOURCES AND REFERENCES

• NRS Chapter 205 (Crimes Against Property) — https://www.leg.state.nv.us/NRS/NRS-205.html
• NRS 205.463 (Unlawful use of personal identifying information) — https://law.justia.com/codes/nevada/chapter-205/statute-205-463/
• NRS Chapter 603A (Security and Privacy of Personal Information) — https://www.leg.state.nv.us/NRS/NRS-603A.html
• NRS 41.600 (Actions by victims of fraud) — https://law.justia.com/codes/nevada/chapter-41/statute-41-600/
• NRS Chapter 598 (Deceptive Trade Practices) — https://www.leg.state.nv.us/NRS/NRS-598.html
• 15 U.S.C. § 1681c-2 (FCRA § 605B — block of identity-theft information) — https://www.law.cornell.edu/uscode/text/15/1681c-2
• 15 U.S.C. § 1681g(e) (FCRA — disclosure of records to ID-theft victim)
• FTC IdentityTheft.gov — https://www.identitytheft.gov/
• FTC FCRA § 605B PDF — https://www.identitytheft.gov/PDFs/FTC_FCRA_605b.pdf
• Nevada Attorney General — Identity Theft Laws — https://ag.nv.gov/Hot_Topics/Victims/IDTheft_Laws/
• IRS Form 14039 only if current IRS instructions call for it, Identity Theft Affidavit — https://www.irs.gov/identity-theft-fraud-scams/identity-theft-guide-for-individuals#form14039
• Social Security Administration OIG — https://oig.ssa.gov/

Disclaimer: This template is provided for informational purposes only and does not constitute legal advice. An attorney licensed in Nevada should review and customize this packet before sending to creditors, credit bureaus, or law enforcement. Laws, citations, and contact addresses change frequently; verify all authorities and recipient addresses before use.