Identity Theft Affidavit and Police Report Cover - Vermont - Preparation Worksheet

VERMONT IDENTITY-INCIDENT PREPARATION PACKET

Do not sign, notarize, file, or send this worksheet. Preserve evidence, address urgent account and safety risks, and transfer reviewed facts into the current official form for each selected recipient.

1. Urgent Safety and Account Controls

☐ Emergency and account-security steps were handled before ordinary documentation work.

☐ Passwords and access credentials were changed through a trusted device and official channel where appropriate.

☐ No suspect link, telephone number, payment instruction, or contact detail was reused without independent confirmation.

2. Person and Incident Record

☐ Facts personally known are separated from information supplied by another person, institution, or system.

☐ Unknowns are identified as unknown rather than filled with assumptions.

3. Information Potentially Exposed or Used

4. Suspect Account and Transaction Schedule

Total confirmed loss: $[________________________________]

Total disputed, pending, or potential exposure: $[________________________________]

5. Chronology

6. Evidence Inventory and Sensitive-Data Control

☐ Preserve originals and metadata.

☐ Do not attach a full Social Security number, account number, password, access code, medical record, or unrelated third-party information unless the current official recipient instructions require it and a secure route is confirmed.

☐ Create a recipient-specific attachment set; do not send one universal identity packet everywhere.

7. Official Route Register

Recheck the current official page and form for each route on the day of use. The available route and required records depend on the incident.

8. Law-Enforcement Report Preparation

This section organizes facts for the agency's current process. It does not demand that an agency accept, investigate, refer, certify, or provide a report.

Agency's current form or statement used: [________________________________]

Report or incident number: [________________________________]

Copy, confirmation, referral, or follow-up: [________________________________]

9. Factual Statement Draft

Use only if the selected official process asks for a narrative. This is not an affidavit or declaration.

I discovered the suspected identity incident on [__/__/____] when [________________________________].

The following information, account, transaction, or conduct was not authorized by me: [________________________________].

The records supporting that statement are [________________________________].

I contacted [________________________________] on [__/__/____], and the response was [________________________________].

The known or suspected loss and continuing risk are [________________________________].

Information I do not know or cannot confirm is [________________________________].

Qualified reviewer: [________________________________]

10. Signature, Oath, and Verification Gate

☐ The selected recipient actually requires a signature, oath, declaration, affidavit, notarization, identification document, or police report.

☐ The exact current official language and form were used.

☐ The signer understands every statement and has identified information based on belief, another source, or incomplete records.

☐ Venue, notarial certificate, identity verification, remote procedure, and commission details were not improvised.

☐ Criminal-warning or penalty language was not added unless the current official form requires it.

11. Credit, Account, and Records Action Tracker

☐ No universal 24-hour, 30-day, four-day, one-year, or seven-year timeline was assumed.

☐ Each route's trigger, deadline, documents, exceptions, and legal effect were confirmed separately.

12. Current-Law Issue Register

13. Submission and Follow-Up Log

☐ Save every final form, attachment set, delivery record, confirmation, report, response, and status screenshot.

☐ Calendar each recipient-specific response or follow-up date from its current official instructions.

☐ Obtain qualified review before signing a release, settlement, repayment plan, affidavit, or other legally operative statement.

This worksheet organizes an identity incident. It does not establish identity theft, make a police report, invoke a credit remedy, prove a loss, or satisfy any official form or deadline.