Identity Theft Affidavit and Police Report Cover (Ohio)

IDENTITY THEFT AFFIDAVIT AND POLICE REPORT COVER — OHIO

TABLE OF CONTENTS

1. Affiant Information
2. Sworn Statement of Identity Theft
3. Schedule A — Fraudulent Accounts and Transactions
4. Schedule B — Documents Attached
5. Cover Letter to Law Enforcement Agency
6. Notarization and Verification
7. Distribution List
8. Ohio Practice Notes
9. Sources and References

1. AFFIANT INFORMATION

2. SWORN STATEMENT OF IDENTITY THEFT

STATE OF OHIO

COUNTY OF [______________]

I, [AFFIANT NAME], after being first duly sworn, depose and state under oath as follows:

2.1. I am the natural person identified in Section 1 above, and I am over the age of 18 and competent to make this Affidavit.

2.2. I am the victim of identity theft as that term is defined by 15 U.S.C. § 1681a(q)(3) and as criminalized in Ohio by Ohio Rev. Code § 2913.49 (Identity Fraud).

2.3. I first became aware of the identity theft on or about [__/__/____] by virtue of [describe — e.g., notice from creditor, denial of credit, debt collection call, suspicious activity on credit report, IRS notice, breach notification under Ohio Rev. Code § 1349.19].

2.4. I did not authorize, consent to, ratify, or benefit from the use of my identifying information in the accounts or transactions identified in Schedule A below.

2.5. I have not and do not give permission to any person to use my name, Social Security number, date of birth, address, Ohio driver's license number, state identification card number, financial account number, or any other "personal identifying information" within the meaning of Ohio Rev. Code § 2913.49(A) to apply for, open, use, or transact business on any account identified in Schedule A.

2.6. To the best of my knowledge and belief, I do not personally know the perpetrator(s) of the identity theft. [OR: To the best of my knowledge and belief, the person(s) responsible for the identity theft is/are: (name(s) and relationship)].

2.7. I have filed or am simultaneously filing this Affidavit with [LAW ENFORCEMENT AGENCY NAME] to obtain a police report concerning the identity theft.

2.8. I have submitted, or am simultaneously submitting, an identity theft report to the Federal Trade Commission via IdentityTheft.gov, and a copy of the FTC affidavit is attached as Exhibit 1.

2.9. ☐ The identity theft is connected to a known security breach for which I received a notification under Ohio Rev. Code § 1349.19 (Ohio Personal Information Protection Act). The breached entity is [ENTITY NAME], and notification was received on [__/__/____]. A copy of the breach notice is attached as Exhibit __.

2.10. I make this Affidavit for the purposes of (i) obtaining a police report; (ii) constituting an "Identity Theft Report" under 15 U.S.C. § 1681a(q)(4) for use with consumer reporting agencies and creditors; (iii) supporting requests under 15 U.S.C. § 1681c-2 to block reporting of fraudulent information; (iv) supporting requests under 15 U.S.C. § 1681g(e) for disclosure of records concerning fraudulent accounts; (v) supporting any criminal investigation, prosecution, or restitution proceeding under Ohio Rev. Code § 2913.49; and (vi) supporting any civil action under Ohio Rev. Code § 2307.60 and/or § 1349.192.

2.11. The statements made in this Affidavit, including those in Schedule A, are true and correct based on my personal knowledge except where stated upon information and belief, and as to those matters I believe them to be true.

[________________________________]

[AFFIANT NAME], Affiant

3. SCHEDULE A — FRAUDULENT ACCOUNTS AND TRANSACTIONS

4. SCHEDULE B — DOCUMENTS ATTACHED

☐ Exhibit 1. FTC IdentityTheft.gov-generated affidavit (printed at completion; cannot be retrieved later).

☐ Exhibit 2. Copy of government-issued photo ID (Ohio driver's license, Ohio state ID, or U.S. passport).

☐ Exhibit 3. Proof of Ohio address (recent utility bill, bank statement, lease, or property tax bill — within last 60 days).

☐ Exhibit 4. Copies of fraudulent account notices, billing statements, or collection letters.

☐ Exhibit 5. Copies of credit reports from Equifax, Experian, and TransUnion with fraudulent items circled.

☐ Exhibit 6. Police report cover letter (Section 5 below) and any prior incident reports.

☐ Exhibit 7. Fraud alert / security freeze confirmations from each of the three nationwide CRAs.

☐ Exhibit 8. Ohio Rev. Code § 1349.19 breach notification (if applicable).

☐ Exhibit 9. Other: [describe].

5. COVER LETTER TO LAW ENFORCEMENT AGENCY

[DATE]

[LAW ENFORCEMENT AGENCY NAME]

Attn: Records Division / Identity Theft Unit

[STREET ADDRESS]

[CITY, OH ZIP]

RE: Request to File a Police Report — Identity Fraud — Ohio Rev. Code § 2913.49

Dear Officer / Records Division:

I am an Ohio resident and the victim of identity fraud as criminalized by Ohio Rev. Code § 2913.49. I am requesting that your agency open an incident report so that I may obtain the documentation necessary to invoke remedies under federal and Ohio law, including the FCRA § 605B block (15 U.S.C. § 1681c-2), restitution under Ohio Rev. Code § 2913.49(I), and a civil action under Ohio Rev. Code § 2307.60.

Attached for your records are:

• This Identity Theft Affidavit (Sections 1 through 6) sworn under oath;
• A schedule of fraudulent accounts and transactions (Schedule A);
• A copy of the FTC IdentityTheft.gov affidavit (Exhibit 1);
• A copy of my government-issued photo ID (Exhibit 2);
• Proof of my Ohio address (Exhibit 3);
• Supporting documentation of fraudulent activity (Exhibit 4);
• Copies of my consumer credit reports with disputed items marked (Exhibit 5).

I respectfully request:

1. That your agency open an incident or case report and provide me a report number and a certified copy of the report when available;
2. That investigative referrals be made to the Ohio Bureau of Criminal Investigation (Ohio Attorney General), the U.S. Postal Inspection Service, the U.S. Secret Service, the Federal Trade Commission, or other agency as warranted;
3. That a copy of the report be flagged for any subsequent restitution proceeding under Ohio Rev. Code § 2913.49(I), and for any victim's-rights notification process under Marsy's Law (Ohio Const. art. I, § 10a) and Ohio Rev. Code Chapter 2930.

I understand that the police report, together with the FTC affidavit, will constitute an "Identity Theft Report" under 15 U.S.C. § 1681a(q)(4), which I will then submit to the consumer reporting agencies and creditors to invoke the blocking and dispute rights afforded by 15 U.S.C. § 1681c-2 and 15 U.S.C. § 1681g(e).

Thank you for your assistance.

Sincerely,

[________________________________]

[AFFIANT NAME]

[CONTACT TELEPHONE / EMAIL]

6. NOTARIZATION AND VERIFICATION

Sworn to and subscribed before me, a notary public, this [____] day of [_______________], 20[____].

[________________________________]

Notary Public

State of Ohio, County of [______________]

My commission expires: [__/__/____]

(Notary Seal)

7. DISTRIBUTION LIST

After execution and (if applicable) issuance of a police report, distribute as follows:

8. OHIO PRACTICE NOTES

• Elements of Ohio identity fraud. Under Ohio Rev. Code § 2913.49(B), no person shall, without express or implied consent, use, obtain, or possess any "personal identifying information" of another with the intent to (i) hold the person out to be the other, (ii) represent the other's information as one's own, (iii) cause disadvantage to the other, or (iv) cause an obligation or liability to be assessed against the other. § 2913.49(A) defines personal identifying information broadly to include name, address, SSN, driver's license number, state ID, account numbers, passwords, mother's maiden name, employer information, and similar data.
• Felony classification escalates with value. § 2913.49(I) makes identity fraud a felony of the fifth degree by default, escalating to a fourth-, third-, second-, or first-degree felony based on value (under $1,000; $1,000–$7,500; $7,500–$150,000; or over $150,000). Enhanced penalties apply when the victim is an "elderly person," "disabled adult," "active duty service member," or "spouse of an active duty service member" — a Court "shall" impose a prison term and may impose a fine up to $50,000 in addition to restitution. § 2913.49(I)(2)–(3).
• Statutory civil right of action. § 2913.49(K) cross-references Ohio Rev. Code § 2307.60, which provides a civil cause of action to anyone "injured in person or property" by a criminal act. The owner of the identifying information may sue for compensatory and punitive damages, attorney's fees, and may also seek injunctive relief.
• Restitution. § 2913.49(I)(2) and Ohio Rev. Code § 2929.18 require the court to order full restitution to the victim, including reasonable attorney's fees and other costs incurred to investigate and resolve the theft. Document time spent, mileage, postage, certified-mail fees, document fees, professional fees, and lost wages.
• Ohio breach notification overlay (R.C. § 1349.19). If the identity theft traces to a security breach by an Ohio business or a business holding Ohio residents' data, the breached entity must notify affected Ohio residents in the most expedient time possible but no later than 45 days from discovery, and must notify all nationwide CRAs if more than 1,000 Ohio residents are affected. § 1349.192 authorizes the Ohio AG to bring civil actions for failure to comply, with civil penalties of up to $10,000 per day for the first 60 days and $50,000 per day thereafter.
• Identity Theft Report under FCRA. The FTC affidavit ALONE is not an "Identity Theft Report" sufficient to compel a § 605B block. It must be paired with a report to a federal, state, or local law-enforcement agency. 16 C.F.R. § 603.3.
• § 605B block timing. A consumer reporting agency must block disputed information within four (4) business days of receiving (i) appropriate proof of identity, (ii) a copy of the Identity Theft Report, and (iii) a statement that the information is not the result of any transaction by the consumer, plus identification of the information to be blocked. 15 U.S.C. § 1681c-2(a).
• § 1681g(e) records request. Within 30 days of receiving a sufficient request from a victim, a creditor or financial institution must furnish business records (application, transaction history, etc.) related to the alleged fraudulent account.
• Free security freeze. Ohio Rev. Code § 1349.52 and federal law (15 U.S.C. § 1681c-1) authorize free security freezes with all three nationwide CRAs. Place freezes immediately to prevent new-account fraud while disputes are pending. A freeze may be temporarily lifted for legitimate credit applications.
• IRS identity theft. If the affiant suspects fraudulent tax filings using their SSN, file IRS Form 14039 and request an Identity Protection PIN.
• BMV driver's license misuse. If the Ohio driver's license number was used, contact the Ohio Bureau of Motor Vehicles to request a fraud review and document the BMV file. Consider requesting a new license number where authorized.
• Avoid revealing full SSN beyond necessary recipients. Use only the last four digits in copies furnished to creditors or third parties; provide full SSN only to law enforcement and credit reporting agencies as required.

9. SOURCES AND REFERENCES

• Ohio Rev. Code § 2913.49 (Identity fraud) — https://codes.ohio.gov/ohio-revised-code/section-2913.49
• Ohio Rev. Code § 2307.60 (Civil action for criminal act) — https://codes.ohio.gov/ohio-revised-code/section-2307.60
• Ohio Rev. Code § 1349.19 (Personal Information Protection Act — breach notification) — https://codes.ohio.gov/ohio-revised-code/section-1349.19
• Ohio Rev. Code § 1349.192 (AG civil enforcement) — https://codes.ohio.gov/ohio-revised-code/section-1349.192
• Ohio Rev. Code § 1349.52 (Security freeze) — https://codes.ohio.gov/ohio-revised-code/section-1349.52
• 15 U.S.C. § 1681a(q) — https://www.law.cornell.edu/uscode/text/15/1681a
• 15 U.S.C. § 1681c-1 (Fraud alerts) — https://www.law.cornell.edu/uscode/text/15/1681c-1
• 15 U.S.C. § 1681c-2 (Block of information resulting from identity theft) — https://www.law.cornell.edu/uscode/text/15/1681c-2
• 15 U.S.C. § 1681g(e) (Records disclosure to victim) — https://www.law.cornell.edu/uscode/text/15/1681g
• 16 C.F.R. § 603.3 (FTC definition of "identity theft report") — https://www.ecfr.gov/current/title-16/section-603.3
• IdentityTheft.gov — https://www.identitytheft.gov/
• Ohio Attorney General — Identity Theft Resources — https://www.ohioattorneygeneral.gov/Individuals-and-Families/Consumers/Identity-Theft-Unit
• Ohio Bureau of Criminal Investigation — https://www.ohioattorneygeneral.gov/Law-Enforcement/Bureau-of-Criminal-Investigation
• Ohio Bureau of Motor Vehicles — https://bmv.ohio.gov

Disclaimer: This template is provided for informational purposes only and does not constitute legal advice. An attorney licensed in Ohio must review and customize this document before use. Laws, citations, and court rules change frequently; verify all authorities before use.