Identity Theft Affidavit and Police Report Cover - South Carolina

IDENTITY THEFT AFFIDAVIT AND POLICE REPORT COVER — SOUTH CAROLINA

TABLE OF CONTENTS

1. Police Report Cover Letter
2. Identity Theft Affidavit
3. Schedule A — Fraudulent Accounts and Transactions
4. FCRA § 1681c-2 Block Request — to Each Nationwide CRA
5. Notarization
6. South Carolina Practice Notes
7. Sources and References

1. POLICE REPORT COVER LETTER

[VICTIM FULL LEGAL NAME]

[STREET ADDRESS]

[CITY, SC ZIP]

Telephone: [________________]

Email: [________________]

Date: [__/__/____]

[POLICE DEPARTMENT NAME]

Attn: Records / Identity Theft / Financial Crimes Unit

[STREET ADDRESS]

[CITY, SC ZIP]

Re: Request to File Identity Theft Police Report Under S.C. Code Ann. § 16-13-510 (Financial Identity Fraud)

Dear Officer in Charge:

I am a resident of [CITY, COUNTY], South Carolina, and I am a victim of identity theft. I am submitting this request and the attached sworn Identity Theft Affidavit to file a police report under S.C. Code Ann. § 16-13-510 (Financial Identity Fraud), which is a felony in South Carolina punishable by up to ten (10) years imprisonment, a fine in the discretion of the court, or both, plus mandatory restitution. As a South Carolina resident, I respectfully request:

1. That a police report be opened and a case number issued;
2. That a copy of the report be provided to me at the address above for use with consumer reporting agencies, creditors, the South Carolina Department of Consumer Affairs, the South Carolina Attorney General's Consumer Protection Division, and federal regulators;
3. That the report identify, where known, each fraudulent account, transaction, or use of my identifying information;
4. That a copy of the report be transmitted, where appropriate, to the South Carolina Law Enforcement Division (SLED), the South Carolina Attorney General, and any out-of-state agency in whose jurisdiction acts in furtherance occurred; and
5. That, if the alleged perpetrator is known to me, I be informed of the steps that will be taken and that the prosecutor be advised that I will request mandatory restitution under S.C. Code Ann. § 16-13-510 if charges are filed.

I have also filed a report with the Federal Trade Commission at IdentityTheft.gov. The FTC report number is [________________________________].

Enclosed are: (a) my sworn Identity Theft Affidavit; (b) Schedule A listing fraudulent accounts; (c) a copy of my government-issued photo ID; (d) proof of address; and (e) supporting documents.

Sincerely,

[________________________________]

[VICTIM NAME]

Enclosures: Affidavit; Schedule A; Photo ID; Proof of address; Supporting documents

2. IDENTITY THEFT AFFIDAVIT

STATE OF SOUTH CAROLINA

COUNTY OF [________________]

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

A. Identity of Affiant

A.1. My full legal name is [________________________________].

A.2. My date of birth is [__/__/____].

A.3. The last four digits of my Social Security number are [XXX-XX-____].

A.4. My current residential address is [STREET, CITY, SC ZIP].

A.5. My residential addresses for the past five (5) years are: [________________________________].

A.6. My driver's license or state-ID number is [________________] issued by [STATE].

B. Statement of Identity Theft

B.1. I am a victim of identity theft as defined by 12 C.F.R. § 1022.3(h) and financial identity fraud as defined by S.C. Code Ann. § 16-13-510. A person or persons unknown to me (or known to me as identified in Paragraph B.5 below) has used or attempted to use my personal identifying information without my permission, and with the intent to unlawfully appropriate my financial resources or to obtain money, property, or services by false pretenses, representations, or promises.

B.2. I first discovered the identity theft on or about [__/__/____] when [DESCRIBE DISCOVERY EVENT — e.g., received collection letter; reviewed credit report; was denied credit; received bill for unknown account; received a S.C. Code § 39-1-90 data-breach notice].

B.3. I did not authorize, consent to, ratify, or benefit from any of the fraudulent accounts, charges, applications, or transactions listed in Schedule A.

B.4. I did not receive any goods, services, money, credit, or other thing of value as a result of the fraudulent accounts and transactions.

B.5. [CHOOSE ONE]

☐ I do NOT know who committed the identity theft.

☐ I DO know or suspect the following person(s) committed the identity theft: [NAME, RELATIONSHIP, ADDRESS].

B.6. I did not authorize anyone to use my identifying information to apply for credit or obtain goods or services. No spouse, partner, parent, child, or other family member has authority to use my identity for any of the accounts or transactions identified in Schedule A.

B.7. The identity theft is associated with [CHOOSE ALL THAT APPLY]:

☐ Stolen wallet, purse, or mail dated [__/__/____].

☐ Lost or stolen Social Security card, driver's license, or other ID.

☐ Data breach involving [NAME OF ENTITY] notified under S.C. Code § 39-1-90 on or about [__/__/____].

☐ Phishing, vishing, or smishing communication received on or about [__/__/____].

☐ Computer or device compromise.

☐ Other: [________________________________].

C. Steps Taken

C.1. I have placed an [INITIAL FRAUD ALERT / EXTENDED FRAUD ALERT / SECURITY FREEZE] with each of the three nationwide consumer reporting agencies pursuant to 15 U.S.C. § 1681c-1 and S.C. Code Ann. § 37-20-160 on [__/__/____]. As a victim of identity theft submitting a copy of this police report or identity-theft report, I am entitled to a security freeze at NO CHARGE under S.C. Code Ann. § 37-20-160 and federal law.

C.2. I have filed an FTC Identity Theft Report at IdentityTheft.gov, FTC Report No. [________________________________].

C.3. I have filed a police report with [POLICE DEPARTMENT], Case No. [________________________________], on [__/__/____].

C.4. I have notified each creditor and financial institution listed in Schedule A by certified mail and have requested in writing that the fraudulent accounts be closed and removed from my credit file.

C.5. I have notified, where applicable, the South Carolina Department of Consumer Affairs (293 Greystone Blvd., Suite 400, Columbia, SC 29210; (800) 922-1594; consumer.sc.gov) and the South Carolina Attorney General's Consumer Protection Division (P.O. Box 11549, Columbia, SC 29211; (803) 734-3970; scag.gov).

C.6. I have not been arrested or charged with any crime arising from the misuse of my identity. (If I have been, the circumstances are: [________________________________].)

D. Acknowledgments

D.1. I acknowledge that knowingly making a false statement on this affidavit may be punishable as perjury under S.C. Code Ann. § 16-9-10 or as filing a false police report under S.C. Code Ann. § 16-17-722.

D.2. I authorize the recipient of this affidavit to use it solely for the purpose of investigating, blocking, or correcting fraudulent accounts and transactions and to share it with law enforcement and consumer reporting agencies for the same purpose.

D.3. I request that all credit bureaus, creditors, and businesses receiving this affidavit:

• Block fraudulent information under 15 U.S.C. § 1681c-2;
• Provide me with copies of all account-opening documents, applications, statements, and transaction records pursuant to 15 U.S.C. § 1681g(e);
• Cease all collection of, and reporting on, the fraudulent accounts.

3. SCHEDULE A — FRAUDULENT ACCOUNTS AND TRANSACTIONS

Total Disputed Amount: $[________________]

4. FCRA § 1681c-2 BLOCK REQUEST

The undersigned hereby requests, pursuant to 15 U.S.C. § 1681c-2, that the consumer reporting agency receiving this affidavit BLOCK all information identified in Schedule A from appearing in any consumer report furnished about the undersigned. Required attachments are enclosed:

1. Proof of identity: copy of government-issued photo ID and Social Security card or substitute proof under 16 C.F.R. § 1022.123;
2. Identity theft report: South Carolina police report (Section 1) and/or FTC IdentityTheft.gov report;
3. Schedule A specifically identifying the information to be blocked; and
4. Sworn statement that the information is not the result of any transaction by the undersigned (Affidavit Paragraphs B.3–B.6 above).

The undersigned further requests, pursuant to 15 U.S.C. § 1681g(e), that all furnishers of the blocked information provide copies of any application, account-opening documents, and transaction records related to the fraudulent accounts.

The undersigned also requests, pursuant to S.C. Code Ann. § 37-20-160, a security freeze on the undersigned's consumer report at NO CHARGE based on the enclosed identity-theft report (S.C. Code § 37-20-160 — fee waiver for identity-theft victims).

Send to each of the following nationwide CRAs:

• Equifax Information Services LLC, P.O. Box 105069, Atlanta, GA 30348 — https://www.equifax.com/personal/credit-report-services/identity-theft-protection/
• Experian, P.O. Box 9554, Allen, TX 75013 — https://www.experian.com/fraud/center.html
• TransUnion LLC, Fraud Victim Assistance Department, P.O. Box 2000, Chester, PA 19016 — https://www.transunion.com/fraud-victim-resource/

5. NOTARIZATION

Signed under the pains and penalties of perjury this [____] day of [_______________], 20[____].

[________________________________]

[VICTIM NAME] — Affiant

STATE OF SOUTH CAROLINA

COUNTY OF [_______________]

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

[________________________________]

Notary Public for South Carolina

Print Name: [________________________________]

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

[NOTARY SEAL]

6. SOUTH CAROLINA PRACTICE NOTES

• Right to a police report. S.C. Code Ann. § 16-13-510 makes financial identity fraud a felony punishable by up to 10 years imprisonment and mandatory restitution. If your local department refuses to take a report, escalate to the South Carolina Law Enforcement Division (SLED) Financial Crimes Unit, the SC AG's Consumer Protection Division ((803) 734-3970), or the SC Department of Consumer Affairs Identity Theft Unit ((800) 922-1594). A police or identity-theft report is essential to obtain an FCRA § 1681c-2 block AND to qualify for the free S.C. Code § 37-20-160 security freeze.
• Mandatory restitution. S.C. Code § 16-13-510 expressly permits the court to order restitution covering direct repayment of stolen funds, documentable financial harm, and expenses or fees incurred as a direct result of the fraud. Document all economic losses, attorney fees, time off work, and out-of-pocket expenses for the restitution petition.
• FTC IdentityTheft.gov report. An FTC Identity Theft Report generated at IdentityTheft.gov may qualify as an "identity theft report" for FCRA purposes under 12 C.F.R. § 1022.3(i). A sufficiently specific official police report is another qualifying route and may also support a local criminal investigation; federal law does not categorically require both reports.
• Free security freeze for victims. Under S.C. Code Ann. § 37-20-160, CRAs must provide and remove a freeze at NO CHARGE to a victim of identity theft submitting an identity-theft report. Federal law (15 U.S.C. § 1681c-1) also makes freezes free nationwide; cite both.
• Data-breach overlay. S.C. Code Ann. § 39-1-90 conditionally requires a covered data owner/licensee to notify affected South Carolina residents and a data maintainer to notify the owner/licensee. Subsection (G) supplies its own injured-resident remedies, subsection (H) supplies an administrative fine for knowing and wilful violations, and subsection (K) adds Department of Consumer Affairs and nationwide consumer-reporting-agency notice when a business notifies more than 1,000 persons at one time. The section does not itself make every violation a SCUTPA violation.
• Identity-theft statutes. Sections 37-20-110 et seq., 39-1-90, and 30-2-310 address different subjects and remedies. Do not combine them into an automatic SCUTPA per se claim; identify the violated provision, claimant, injury, state of mind, and authorized remedy under current authority.
• SCUTPA "public interest" prong (CRITICAL). Under Daisy Outdoor Advertising Co. v. Abbott, 322 S.C. 489, 473 S.E.2d 47 (1996), private SCUTPA actions require evidence of a "potential for repetition." Do not assume a breach or credit-furnishing dispute satisfies that requirement; plead and prove current claim-specific facts and authority.
• No private SCUTPA class actions. S.C. Code § 39-5-140 limits private SCUTPA recovery to individual actions ("not in a representative capacity"). Class treatment of FCRA or breach claims may proceed under federal procedure (Fed. R. Civ. P. 23).
• Tax-related identity theft. File IRS Form 14039 only if current IRS instructions call for it (Identity Theft Affidavit) and notify the South Carolina Department of Revenue (dor.sc.gov; (803) 898-5444) if state tax filings are affected. Place an IRS Identity Protection PIN.
• Medical identity theft. Send an additional dispute and request for accounting under HIPAA (45 C.F.R. § 164.528) to each medical provider. Hospitals and physician offices are covered entities and must respond within 60 days.
• Criminal identity theft. If charges have been filed against you in someone else's name, work with the prosecutor and court to obtain a "clearance letter" or affidavit of factual innocence and ensure NCIC and SLED records are updated.
• Civil remedies. Where the theft was facilitated by a creditor's failure to follow reasonable account-opening procedures, consider FCRA § 1681s-2 furnisher claims and a SCUTPA claim under § 39-5-140 (treble damages for willful violations + mandatory attorney's fees).
• Continuing duty to monitor. Identity theft often manifests in waves over 12–36 months. Pull all three credit reports quarterly via AnnualCreditReport.com and re-dispute new fraud as it appears. Renew the fraud alert annually if not converted to a freeze.

7. SOURCES AND REFERENCES

• S.C. Code Ann. § 16-13-510 (Financial Identity Fraud) — https://www.scstatehouse.gov/code/t16c013.php
• S.C. Code Ann. § 37-20-110 et seq. (Consumer Identity Theft Protection) — https://www.scstatehouse.gov/code/t37c020.php
• S.C. Code Ann. § 37-20-160 (Security freeze — fee waiver) — https://www.scstatehouse.gov/code/t37c020.php
• S.C. Code Ann. § 39-1-90 (Notice of Security Breach) — https://www.scstatehouse.gov/code/t39c001.php
• S.C. Code Ann. § 39-5-10 et seq. (SCUTPA) — https://www.scstatehouse.gov/code/t39c005.php
• South Carolina Financial Identity Fraud and Identity Theft Protection Act (Act No. 190 of 2008) — https://www.scstatehouse.gov/sess117_2007-2008/bills/453.htm
• Daisy Outdoor Advertising Co. v. Abbott, 322 S.C. 489, 473 S.E.2d 47 (1996)
• 15 U.S.C. § 1681c-2 (FCRA block) — https://www.consumerfinance.gov/rules-policy/regulations/1022/
• FTC IdentityTheft.gov — https://www.identitytheft.gov/
• FTC Identity Theft Affidavit — https://www.identitytheft.gov/Assistant
• South Carolina Department of Consumer Affairs Identity Theft Resources — https://consumer.sc.gov/
• SCDCA FIFITPA Brochure — https://consumer.sc.gov/sites/consumer/files/Documents/FIFITPABrochure2025.pdf
• South Carolina Attorney General Consumer Protection — https://www.scag.gov/inside-the-office/legal-services-division/consumer-protection-antitrust/
• South Carolina Law Enforcement Division (SLED) — https://www.sled.sc.gov/
• IRS Form 14039 only if current IRS instructions call for it — https://www.irs.gov/identity-theft-fraud-scams/identity-theft-guide-for-individuals#form14039

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