Identity Theft Affidavit and Police Report Cover - South Dakota

IDENTITY THEFT AFFIDAVIT AND POLICE REPORT COVER PACKET — SOUTH DAKOTA

TABLE OF CONTENTS

1. Part A — Identity Theft Affidavit (Sworn)
2. Part B — Police Report Cover Letter
3. Part C — Cover Letter to Creditors and Consumer Reporting Agencies
4. Part D — FCRA Block / Furnisher Notice
5. South Dakota Practice Notes
6. Sources and References

1. PART A — IDENTITY THEFT AFFIDAVIT (SWORN)

STATE OF SOUTH DAKOTA

COUNTY OF [COUNTY]

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

A.1. VICTIM IDENTIFICATION

A.1.1. My full legal name is [VICTIM FULL LEGAL NAME].

A.1.2. My date of birth is [__/__/____].

A.1.3. My Social Security number ends in [XXXX] (last four digits only — full number provided under separate sealed cover).

A.1.4. My current residence address is [STREET], [CITY], South Dakota [ZIP].

A.1.5. My telephone number is [NUMBER]; my email is [EMAIL].

A.1.6. I am the victim of identity theft as defined by 15 U.S.C. § 1681a(q)(3) and by SDCL § 22-40-8.

A.2. STATEMENT OF FACTS

A.2.1. On or about [DATE], I first discovered that I am a victim of identity theft. I learned of the theft by [describe — e.g., received a credit card or collection notice for an account I did not open; received an IRS notice; was denied credit; received a data-breach notification; was contacted by law enforcement].

A.2.2. I did not authorize, consent to, or benefit from any of the unauthorized accounts, transactions, or charges described below.

A.2.3. I do not know the perpetrator's identity. [OR: I believe the perpetrator is __________ for the following reasons: __________.]

A.2.4. [OPTIONAL — DATA BREACH NEXUS] On or about [DATE], I received notification under the South Dakota Notification of Risk to Personal Data Act, SDCL §§ 22-40-19 to 22-40-26, from [INFORMATION HOLDER] advising me that my personal information had been compromised in a data security breach. I believe the identity theft described in this affidavit is causally related to that breach.

A.3. UNAUTHORIZED ACCOUNTS, TRANSACTIONS, AND INQUIRIES

A.3.1. The above accounts and transactions were opened and/or used without my knowledge, consent, or authorization.

A.3.2. I did not benefit from the proceeds of any of the above transactions and have not ratified them at any time.

A.3.3. [INQUIRIES — IF APPLICABLE] The following hard inquiries on my consumer report were not authorized by me: [LIST INQUIRIES].

A.4. ACTIONS ALREADY TAKEN

A.4.1. ☐ I have placed an initial fraud alert under 15 U.S.C. § 1681c-1(a) with [Equifax / Experian / TransUnion] on [__/__/____].

A.4.2. ☐ I have placed a security freeze under 15 U.S.C. § 1681c-1(i) with each of the three nationwide consumer reporting agencies.

A.4.3. ☐ I have filed an identity-theft report with the Federal Trade Commission at IdentityTheft.gov on [__/__/____] (Reference No. [________]).

A.4.4. ☐ I have filed (or will file concurrently with this affidavit) a report with the [NAME OF LAW ENFORCEMENT AGENCY] in [CITY/COUNTY], South Dakota.

A.4.5. ☐ I have notified each affected financial institution and creditor in writing.

A.4.6. ☐ I have changed all known account passwords and PINs.

A.5. DECLARATION AND VERIFICATION

A.5.1. I declare under penalty of perjury under the laws of the State of South Dakota and of the United States that the foregoing is true and correct to the best of my knowledge.

A.5.2. I understand that knowingly making a false statement to a law enforcement officer or in a sworn affidavit may constitute a separate criminal offense under SDCL § 22-29-9.5 (false reports to law enforcement) and § 22-29-1 (perjury).

Date: [__/__/____]

[________________________________]

[VICTIM NAME]

A.6. JURAT

Subscribed and sworn to before me this [____] day of [_______________], 20[____].

[________________________________]

Notary Public — State of South Dakota

(My Commission Expires: [_______________])

2. PART B — POLICE REPORT COVER LETTER

[VICTIM NAME]

[STREET ADDRESS]

[CITY, SD ZIP]

Date: [__/__/____]

To: [NAME OF LAW ENFORCEMENT AGENCY]

[STREET ADDRESS]

[CITY, SD ZIP]

Re: Request to Take Police Report for Identity Theft — SDCL § 22-40-8

Dear Records Officer / Investigations Unit:

I am a resident of [CITY/COUNTY], South Dakota, and the victim of identity theft as defined by SDCL § 22-40-8. I respectfully request that your agency open a case file and provide me with a written report (or case number) so that I can comply with my obligations under the federal Fair Credit Reporting Act, 15 U.S.C. §§ 1681c-1, 1681c-2, and 1681g(e).

Enclosed are:

• Exhibit A — Identity Theft Affidavit, sworn under penalty of perjury;
• Exhibit B — Documentation of the unauthorized accounts, transactions, and inquiries (account statements, collection letters, credit-report excerpts);
• Exhibit C — FTC Identity Theft Report (IdentityTheft.gov), Reference No. [________];
• Exhibit D — Government-issued photo identification (copy);
• Exhibit E — Proof of South Dakota residence (utility bill / lease).

I understand that under SDCL § 22-40-8, identity theft is a Class 6 felony in South Dakota. I am prepared to cooperate fully with any investigation, including providing additional documentation, sitting for an interview, and testifying if requested.

Please mail or email a copy of the report or case number to me at the address above.

Sincerely,

[________________________________]

[VICTIM NAME]

3. PART C — COVER LETTER TO CREDITORS AND CONSUMER REPORTING AGENCIES

[VICTIM NAME]

[STREET ADDRESS]

[CITY, SD ZIP]

Date: [__/__/____]

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

Tracking No. [________________________________]

To: [CREDITOR / FURNISHER / CRA]

[ATTN: FRAUD / IDENTITY THEFT DEPARTMENT]

[STREET ADDRESS]

[CITY, STATE ZIP]

Re: Identity Theft Notice and Demand to Block / Remove Disputed Information

Dear Sir/Madam:

I am the victim of identity theft. I did not open, authorize, consent to, or benefit from the account or transaction referenced below:

• Account / Reference No.: [ACCOUNT NUMBER — LAST 4]
• Alleged Balance: $[AMOUNT]
• Date Reported / Opened: [__/__/____]

Enclosed are:

• Exhibit A — Sworn Identity Theft Affidavit;
• Exhibit B — Identity Theft Report (police report or FTC report);
• Exhibit C — Government-issued photo identification (copy);
• Exhibit D — Proof of address (utility bill / lease).

Pursuant to 15 U.S.C. § 1681c-2, I demand that you BLOCK the reporting of any information resulting from this identity theft within four (4) business days of receipt of this notice. Pursuant to 15 U.S.C. § 1681s-2(a)(6) and 15 U.S.C. § 1681s-2(b), I demand that you cease furnishing the disputed information, conduct a reasonable investigation, and report the account as resulting from identity theft.

Pursuant to 15 U.S.C. § 1681g(e), I request that you provide me with copies of all application and transaction records relating to the disputed account within thirty (30) days.

If you continue to attempt collection of, or to report, the disputed account after receipt of this notice, you may be liable to me for actual damages, statutory damages, and reasonable attorney fees under the FCRA and the FDCPA (where applicable), and for actual damages and reasonable attorney fees under the South Dakota Deceptive Trade Practices and Consumer Protection Act, SDCL § 37-24-31.

Sincerely,

[________________________________]

[VICTIM NAME]

4. PART D — FCRA BLOCK / FURNISHER NOTICE

FORMAL DEMAND TO BLOCK INFORMATION RESULTING FROM IDENTITY THEFT

To: [CONSUMER REPORTING AGENCY]

Pursuant to 15 U.S.C. § 1681c-2(a), I, [VICTIM NAME], the consumer identified in the enclosed Identity Theft Report, hereby demand that you BLOCK from my consumer file the following information that resulted from the alleged identity theft:

• Item 1: [CREDITOR / TRADELINE / INQUIRY DESCRIPTION]
• Item 2: [CREDITOR / TRADELINE / INQUIRY DESCRIPTION]
• Item 3: [CREDITOR / TRADELINE / INQUIRY DESCRIPTION]

I have provided: (a) appropriate proof of identity (15 U.S.C. § 1681c-2(a)(1)); (b) a copy of the Identity Theft Report (15 U.S.C. § 1681c-2(a)(2)); (c) the identification of the information to be blocked (15 U.S.C. § 1681c-2(a)(3)); and (d) a statement that the information does not relate to any transaction by me (15 U.S.C. § 1681c-2(a)(4)).

You are required to block the information no later than four (4) business days after the date of receipt and to promptly notify the furnisher of the block. 15 U.S.C. § 1681c-2(b).

Sincerely,

[________________________________]

[VICTIM NAME]

Date: [__/__/____]

5. SOUTH DAKOTA PRACTICE NOTES

• South Dakota identity-theft criminal statute. SDCL § 22-40-8 makes identity theft a Class 6 felony. The historical citation SDCL § 22-30A-3.1 was transferred to chapter 22-40 effective July 1, 2006; references in older materials must be updated. Penalty enhancements apply under SDCL § 22-40-9 for repeat offenders or for thefts involving aggregated losses.
• South Dakota Notification of Risk to Personal Data Act. SDCL §§ 22-40-19 to 22-40-26. Information holders that conduct business in South Dakota must (a) notify affected residents within sixty (60) days of discovering a breach (SDCL § 22-40-20), (b) notify the South Dakota Attorney General if more than 250 residents are affected (SDCL § 22-40-22), and (c) notify all consumer reporting agencies if more than 250 residents are affected. The Act includes a harm-threshold exception (no notification if the information holder reasonably determines the breach is not likely to result in harm, with documentation retained for at least three years and notice to the AG).
• SD DTPA enforcement of breach-related conduct. Failure to comply with SDCL §§ 22-40-19 to 22-40-26 is a deceptive act or practice under the SD Deceptive Trade Practices Act and is enforceable by the AG. Private claimants may pursue remedies under SDCL § 37-24-31 to the extent the conduct falls within SDCL § 37-24-6 — note the narrow scope confirmed by Brookings Mall, Inc. v. Cpt. Ahab's, Ltd., 300 N.W.2d 259 (S.D. 1980).
• FCRA block. 15 U.S.C. § 1681c-2 requires a CRA to block information resulting from identity theft within FOUR (4) business days of receiving (i) appropriate proof of identity, (ii) a copy of an Identity Theft Report, (iii) identification of the items to be blocked, and (iv) a statement that the information does not relate to any transaction by the consumer.
• Definition of Identity Theft Report. Under 16 C.F.R. § 603.3, an Identity Theft Report is a report (1) alleging an identity theft, (2) that is a copy of an official, valid report filed by a consumer with an appropriate Federal, State, or local law enforcement agency, including the FTC, the U.S. Postal Inspection Service, or other Federal agency, and (3) the filing of which subjects the person filing the report to criminal penalties relating to false statements.
• Fraud alerts and security freezes. Initial fraud alerts last one year (15 U.S.C. § 1681c-1(a)) and require only an oral or written request. Extended fraud alerts last seven years and require an Identity Theft Report. Security freezes are free under federal law (Economic Growth, Regulatory Relief, and Consumer Protection Act of 2018) and apply with each of the three nationwide CRAs.
• Tax-related identity theft. File IRS Form 14039 (Identity Theft Affidavit) and request an IRS Identity Protection PIN.
• Free South Dakota credit-report monitoring resources. Under federal law, consumers are entitled to one free report per year from each nationwide CRA at AnnualCreditReport.com; weekly free reports were extended permanently in 2023.
• Statute of limitations on civil claims. FCRA private actions: TWO (2) years from discovery, FIVE (5) years outside (15 U.S.C. § 1681p). SD DTPA: FOUR (4) years (SDCL § 37-24-33). Common-law tort claims (e.g., negligence, invasion of privacy): three to six years depending on theory; consult SDCL ch. 15-2.
• Consumer Sentinel. Federal, state, and local law enforcement access reports filed at IdentityTheft.gov through the FTC's Consumer Sentinel Network.

6. SOURCES AND REFERENCES

• Fair Credit Reporting Act, 15 U.S.C. § 1681 et seq. — https://www.law.cornell.edu/uscode/text/15/chapter-41/subchapter-III
• 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) (disclosure to identity-theft victim) — https://www.law.cornell.edu/uscode/text/15/1681g
• 15 U.S.C. § 1681s-2 (responsibilities of furnishers) — https://www.law.cornell.edu/uscode/text/15/1681s-2
• 16 C.F.R. § 603.3 (definition of Identity Theft Report) — https://www.ecfr.gov/current/title-16/chapter-I/subchapter-F/part-603
• South Dakota Identity Crimes Act, SDCL ch. 22-40 — https://sdlegislature.gov/Statutes/22-40
• SDCL § 22-40-8 (identity theft — Class 6 felony) — https://sdlegislature.gov/Statutes/22-40-8
• SDCL §§ 22-40-19 to 22-40-26 (Notification of Risk to Personal Data Act) — https://sdlegislature.gov/Statutes/22-40
• SDCL § 22-40-22 (notice to Attorney General) — https://sdlegislature.gov/Statutes/22-40-22
• South Dakota Deceptive Trade Practices Act, SDCL ch. 37-24 — https://sdlegislature.gov/Statutes/37-24
• South Dakota Attorney General — Division of Consumer Protection — https://consumer.sd.gov/
• South Dakota Consumer Protection — Security Breach Fast Facts — https://consumer.sd.gov/fastfacts/securitybreach.aspx
• FTC IdentityTheft.gov — https://www.identitytheft.gov/
• IRS Form 14039 (Identity Theft Affidavit) — https://www.irs.gov/forms-pubs/about-form-14039
• AnnualCreditReport.com — https://www.annualcreditreport.com/
• Equifax Fraud / Freeze — https://www.equifax.com/personal/credit-report-services/credit-fraud-alerts/
• Experian Fraud / Freeze — https://www.experian.com/fraud/center.html
• TransUnion Fraud / Freeze — https://www.transunion.com/fraud-alerts

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