Identity Theft Affidavit and Police Report Cover (Tennessee)

IDENTITY THEFT AFFIDAVIT AND POLICE REPORT COVER LETTER — TENNESSEE

TABLE OF CONTENTS

1. Police Report Cover Letter
2. Identity Theft Affidavit (Tennessee)
3. Schedule A — Fraudulent Accounts and Transactions
4. Schedule B — Supporting Documents Inventory
5. FCRA Block Request Letter (To Each CRA)
6. Distribution Checklist
7. Tennessee Practice Notes
8. Sources and References

1. POLICE REPORT COVER LETTER

[VICTIM FULL NAME]

[STREET ADDRESS]

[CITY, TN ZIP]

[(___) ___-____]

Date: [__/__/____]

[POLICE DEPARTMENT / SHERIFF'S OFFICE NAME]

Records / Identity Theft Unit

[STREET ADDRESS]

[CITY, TN ZIP]

Re: Request for Identity Theft Police Report — T.C.A. § 39-14-150(g)

Dear Records Officer:

I am a victim of identity theft and respectfully request that your department prepare a written police report documenting the offense. Pursuant to Tennessee Code Annotated § 39-14-150(g), a local law enforcement agency must take a written report from a victim of identity theft, even if the offense occurred outside the agency's jurisdiction.

Enclosed for your file are:

• ☐ My government-issued photo identification (copy);
• ☐ A completed and notarized Identity Theft Affidavit;
• ☐ Schedule A listing the fraudulent accounts and transactions;
• ☐ Schedule B inventorying supporting documents;
• ☐ My Federal Trade Commission Identity Theft Report number (if generated): [FTC Report No.]

I request that the report include the following statutory recital:

"Reporting party identifies herself/himself as a victim of identity theft and provides a sworn affidavit under T.C.A. § 39-14-150 and 18 U.S.C. § 1028(a). The acts complained of include unauthorized use of personal identifying information and fraudulent account openings."

Please provide me with: (a) the case number; (b) a stamped, certified copy of the report; and (c) the contact information for any assigned investigator. I will use the report to invoke FCRA blocking under 15 U.S.C. § 1681c-2 and to dispute fraudulent furnisher information under 15 U.S.C. § 1681s-2.

Thank you for your assistance.

Sincerely,

[________________________________]

[VICTIM FULL NAME]

2. IDENTITY THEFT AFFIDAVIT (Tennessee)

STATE OF TENNESSEE

COUNTY OF [COUNTY]

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

A. Affiant Identification

A.1. My full legal name is [FULL LEGAL NAME].

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 residence address is [STREET ADDRESS, CITY, TN ZIP].

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

A.6. My government-issued photo identification is a [Tennessee Driver License / Tennessee ID / U.S. Passport], number [NUMBER], expiring [__/__/____].

B. Statement of Identity Theft

B.1. I am a victim of identity theft as defined by 18 U.S.C. § 1028(a), 15 U.S.C. § 1681a(q)(3), and T.C.A. § 39-14-150.

B.2. I did not authorize, consent to, or benefit from the accounts, transactions, or activities listed on Schedule A attached hereto.

B.3. I first discovered the identity theft on or about [__/__/____] when [describe how discovered: credit-monitoring alert, denied application, collection notice, etc.].

B.4. To the best of my knowledge, the identity thief is [unknown / known and identified as ____].

B.5. I [have / have not] previously filed a report concerning this identity theft. If yes: [agency, date, report number].

C. Specific Denials

C.1. I did not apply for, open, or authorize the opening of any of the accounts listed on Schedule A.

C.2. I did not authorize any person to use my personal identifying information to obtain credit, goods, services, employment, medical care, government benefits, or to file any tax return or other government filing on my behalf, except as expressly disclosed in this affidavit.

C.3. I did not receive any benefit, money, goods, or services from the fraudulent accounts or transactions listed on Schedule A.

D. Cooperation and Authorization

D.1. I am willing to assist law enforcement in the prosecution of the person(s) responsible.

D.2. I authorize each consumer reporting agency, financial institution, creditor, furnisher, telecommunications provider, and government agency receiving a copy of this affidavit to release to the requesting law enforcement agency any records relevant to the alleged identity theft.

D.3. I request that each consumer reporting agency block the reporting of any information resulting from the identity theft pursuant to 15 U.S.C. § 1681c-2 and place an extended fraud alert on my file pursuant to 15 U.S.C. § 1681c-1(b).

D.4. I request that each consumer reporting agency place a security freeze on my consumer file pursuant to T.C.A. § 47-18-2107.

E. Verification

E.1. The statements in this affidavit and the attached Schedules A and B are true and correct to the best of my knowledge, information, and belief.

E.2. I understand that any false statement made herein may subject me to criminal penalties for perjury under T.C.A. § 39-16-702 and 18 U.S.C. § 1621.

[________________________________]

[VICTIM FULL LEGAL NAME]

Notary Acknowledgment

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

[________________________________]

Notary Public, State of Tennessee

(My Commission Expires: [_______________])

3. SCHEDULE A — FRAUDULENT ACCOUNTS AND TRANSACTIONS

For each entry above, the affiant denies authorizing, consenting to, or benefiting from the account or transaction.

4. SCHEDULE B — SUPPORTING DOCUMENTS INVENTORY

• ☐ Copy of government-issued photo identification.
• ☐ Proof of current residence (utility bill, lease, mortgage statement).
• ☐ Credit reports from Equifax, Experian, and TransUnion with fraudulent items circled.
• ☐ Account statements or correspondence from each fraudulent furnisher.
• ☐ Collection letters received.
• ☐ Police report and case number (if obtained).
• ☐ FTC IdentityTheft.gov report number.
• ☐ Bank or card-issuer fraud reports.
• ☐ Tennessee Attorney General Division of Consumer Affairs complaint receipt (if filed).
• ☐ Other: [describe].

5. FCRA BLOCK REQUEST LETTER (To Each CRA)

[VICTIM FULL NAME]

[STREET ADDRESS]

[CITY, TN ZIP]

Date: [__/__/____]

Sent Via U.S. Certified Mail, Return Receipt Requested

Tracking No.: [________________________________]

[CRA — Equifax / Experian / TransUnion]

[CRA Address]

Re: Request for Block of Information Resulting from Identity Theft — 15 U.S.C. § 1681c-2

Dear Sir or Madam:

I am a victim of identity theft. Pursuant to 15 U.S.C. § 1681c-2 and 12 C.F.R. § 1022.3, I demand that you block from my consumer file the items of information identified on the attached Schedule A as resulting from the identity theft.

Enclosed are:

• ☐ A copy of my government-issued photo identification;
• ☐ A copy of my notarized Identity Theft Affidavit;
• ☐ A copy of the police report dated [__/__/____], case number [NUMBER], from [AGENCY];
• ☐ A copy of my FTC Identity Theft Report (Report No.: [NUMBER]);
• ☐ Schedule A listing the items to be blocked.

You must complete the block no later than four (4) business days after receipt of this notice (15 U.S.C. § 1681c-2(a)). Please confirm in writing once the block has been placed and notify the furnishers as required by 15 U.S.C. § 1681c-2(b).

In addition, I request:

• ☐ An extended fraud alert under 15 U.S.C. § 1681c-1(b) for a period of seven (7) years; and
• ☐ A security freeze on my consumer file under T.C.A. § 47-18-2107 and 15 U.S.C. § 1681c-1(i).

Sincerely,

[________________________________]

[VICTIM FULL NAME]

6. DISTRIBUTION CHECKLIST

• ☐ Local Tennessee law enforcement agency (police/sheriff) — with police report cover letter.
• ☐ Federal Trade Commission — IdentityTheft.gov.
• ☐ Equifax — P.O. Box 105069, Atlanta, GA 30348-5069 — equifax.com/personal/credit-report-services.
• ☐ Experian — P.O. Box 9554, Allen, TX 75013 — experian.com/fraud.
• ☐ TransUnion — P.O. Box 2000, Chester, PA 19016 — transunion.com/credit-help.
• ☐ Each affected creditor / furnisher (with FCRA § 1681s-2(a)(6) dispute language).
• ☐ Tennessee Attorney General Division of Consumer Affairs — P.O. Box 20207, Nashville, TN 37202-0207 — (615) 741-4737 / (800) 342-8385.
• ☐ Tennessee Department of Revenue — if tax-related identity theft.
• ☐ Internal Revenue Service — IRS Form 14039 (Identity Theft Affidavit).
• ☐ Social Security Administration — if SSN misuse.
• ☐ U.S. Postal Inspection Service — if mail used in furtherance of theft.

7. TENNESSEE PRACTICE NOTES

• T.C.A. § 39-14-150 — Identity Theft Victims' Rights Act of 2004. Identity theft is a Class D felony in Tennessee; identity-theft trafficking is a Class C felony. Subsection (g) imposes an obligation on local law enforcement agencies to take a victim's report regardless of where the underlying offense occurred. Use the police report cover letter to invoke that duty.
• Tennessee Identity Theft Deterrence Act. T.C.A. § 47-18-2101 et seq. prohibits the obtaining, possessing, transferring, or using of another's personal identifying information without consent and authorizes a private cause of action (T.C.A. § 47-18-2104) for actual damages, injunctive relief, treble damages on willful violations, and reasonable attorney fees.
• Security freeze under T.C.A. § 47-18-2107. Tennessee residents may request a security freeze from each nationwide CRA at no charge. The freeze must be implemented within three (3) business days of receipt of the request.
• FCRA blocking. 15 U.S.C. § 1681c-2 requires CRAs to block information identified by the consumer as resulting from identity theft within four (4) business days of receipt of (i) the consumer's identity theft report, (ii) identification, and (iii) a statement that the information is not the consumer's. The block extends to furnishers under § 1681c-2(b).
• Identity Theft Report. The FTC IdentityTheft.gov report plus a police report jointly satisfy the "identity theft report" definition at 15 U.S.C. § 1681a(q)(4). Both should be obtained.
• Credit-card fraud / unauthorized EFT. 15 U.S.C. § 1643 (credit) and 15 U.S.C. § 1693g (debit / EFT) cap consumer liability when timely reported. Send written notices of error to each affected institution.
• Tax-related identity theft. File IRS Form 14039 and a Tennessee Department of Revenue inquiry if state tax filings or refunds were affected.
• Notary. Tennessee notaries operate under T.C.A. Title 8, Chapter 16. Online notarization is permitted under the Online Notary Public Act, T.C.A. § 8-16-301 et seq.
• Statute of limitations. Most Tennessee tort and consumer claims arising from identity theft accrue on discovery (T.C.A. § 47-18-110 (one year for TCPA); T.C.A. § 28-3-104 (one year personal injuries); T.C.A. § 28-3-105 (three years property)). Calendar carefully.

8. SOURCES AND REFERENCES

• T.C.A. § 39-14-150 (Identity theft victims' rights) — https://law.justia.com/codes/tennessee/title-39/chapter-14/part-1/section-39-14-150/
• T.C.A. § 47-18-2101 et seq. (Identity Theft Deterrence) — https://law.justia.com/codes/tennessee/title-47/chapter-18/part-21/
• T.C.A. § 47-18-2107 (Security freeze) — https://law.justia.com/codes/tennessee/title-47/chapter-18/part-21/
• 15 U.S.C. § 1681c-2 (FCRA block) — https://www.consumerfinance.gov/rules-policy/regulations/1022/
• FTC IdentityTheft.gov — https://www.identitytheft.gov/
• IRS Form 14039 — https://www.irs.gov/forms-pubs/about-form-14039
• Tennessee Attorney General Division of Consumer Affairs — https://www.tn.gov/attorneygeneral/working-for-tennessee/consumer-affairs.html
• Equifax fraud alerts — https://www.equifax.com/personal/credit-report-services/credit-fraud-alerts/
• Experian fraud center — https://www.experian.com/fraud/center.html
• TransUnion fraud victim resources — https://www.transunion.com/fraud-victim-resource/place-fraud-alert

Disclaimer: This template is provided for informational purposes only and does not constitute legal advice. Have a Tennessee-licensed attorney review your facts before submission. Statutes change; verify all citations before use.