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

IDENTITY THEFT AFFIDAVIT AND POLICE REPORT COVER PACKET — WYOMING

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. Wyoming Practice Notes
6. Sources and References

1. PART A — IDENTITY THEFT AFFIDAVIT (SWORN)

STATE OF WYOMING

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], Wyoming [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 Wyo. Stat. § 6-3-901.

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 Wyoming Breach of Security Notification statute, Wyo. Stat. §§ 40-12-501 through 40-12-509, from [INFORMATION HOLDER] advising me that my personal identifying information had been compromised in a security breach. I believe the identity theft described in this affidavit is causally related to that breach. A copy of the breach notice is attached as Exhibit 1.

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.3.4. The aggregate economic benefit gained or attempted by the perpetrator is approximately $[AMOUNT]. [Check applicable box:] ☐ Less than $1,000 (misdemeanor under Wyo. Stat. § 6-3-901(c)(i)); ☐ $1,000 or more (felony under Wyo. Stat. § 6-3-901(c)(ii)).

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], Wyoming.

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.4.7. ☐ I have notified the Wyoming Attorney General — Consumer Protection and Antitrust Unit at [email protected] / (307) 777-6397.

A.5. DECLARATION AND VERIFICATION

A.5.1. I declare under penalty of perjury under the laws of the State of Wyoming 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 Wyo. Stat. § 6-5-303 (false swearing) and § 6-5-301 (perjury).

Date: [__/__/____]

[________________________________]

[VICTIM NAME]

A.6. JURAT

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

[________________________________]

Notary Public — State of Wyoming

(My Commission Expires: [_______________])

2. PART B — POLICE REPORT COVER LETTER

[VICTIM NAME]

[STREET ADDRESS]

[CITY, WY ZIP]

Date: [__/__/____]

To: [NAME OF LAW ENFORCEMENT AGENCY]

[STREET ADDRESS]

[CITY, WY ZIP]

Re: Request to Take Police Report for Identity Theft — Wyo. Stat. § 6-3-901

Dear Records Officer / Investigations Unit:

I am a resident of [CITY/COUNTY], Wyoming, and the victim of identity theft as defined by Wyo. Stat. § 6-3-901. 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 Wyoming residence (utility bill / lease).

I understand that under Wyo. Stat. § 6-3-901(c), theft of identity is a misdemeanor punishable by up to six (6) months imprisonment, a fine of up to $750.00, or both, when the economic benefit gained or attempted is less than $1,000, and a felony punishable by up to ten (10) years imprisonment, a fine of up to $10,000.00, or both, when the economic benefit is $1,000 or more. Based on the figures in my affidavit, the appropriate charging level is [misdemeanor / felony].

I further request that any restitution order entered pursuant to Wyo. Stat. §§ 7-9-101 through 7-9-115 include the costs I have incurred as a result of the theft, including attorney fees, costs of clearing my credit history or credit rating, and costs in connection with any civil or administrative proceeding to satisfy any debt, lien, or other obligation arising as a result of the perpetrator's actions, as authorized by Wyo. Stat. § 6-3-901(d).

I am prepared to cooperate fully with any investigation, including providing additional documentation, sitting for an interview, and testifying if requested. I also request that, if I am charged in any criminal proceeding initiated as a result of this perpetrator's conduct, the court records reflect that I did not commit the offense, as authorized by Wyo. Stat. § 6-3-901(e).

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, WY 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 (Wyoming police report or FTC report);
• Exhibit C — Government-issued photo identification (copy);
• Exhibit D — Proof of address (utility bill / lease).

Consumer reporting agency route: subject to § 1681c-2's four required items, exceptions, and decline-or-rescission rules, block the identified information within four business days and promptly give the furnisher the notice required by subsection (b).

Furnisher route: if this identity theft report is submitted to your specified address and states that the identified information resulted from identity theft, apply § 1681s-2(a)(6)(B)'s non-furnishing rule unless you subsequently know, or I inform you, that the information is correct. A direct consumer notice does not by itself invoke § 1681s-2(b)'s separate CRA-notice investigation duties.

Covered-business route: under § 1681g(e), treat the separately addressed written request and verification materials as a request for controlled application and transaction records, subject to the subsection's identity, claim, scope, refusal, other-law, and availability conditions.

Remedies depend on the exact duty, recipient, notice route, and proof. This packet does not characterize every continued collection or report as creating FCRA statutory damages or attorney fees.

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. WYOMING PRACTICE NOTES

• Wyoming identity-theft criminal statute. Wyo. Stat. § 6-3-901 ("Unauthorized use of personal identifying information") makes theft of identity a misdemeanor (up to 6 months / $750 fine) when the economic benefit is less than $1,000, and a felony (up to 10 years / $10,000 fine) when the economic benefit is $1,000 or more. The statute defines "personal identifying information" broadly to include name, address, telephone number, SSN, driver's license number, financial account/card numbers with security codes, federal/state/tribal IDs, shared secrets and security tokens, online-account credentials, birth/marriage certificates, medical and health-insurance information, biometric data, and individual taxpayer identification numbers. Wyo. Stat. § 6-3-901(b).
• Restitution and civil costs. Wyo. Stat. § 6-3-901(d), in conjunction with Wyo. Stat. §§ 7-9-101 through 7-9-115, authorizes the criminal court to order the defendant to pay restitution covering the victim's costs, including attorney fees, credit-repair costs, and costs of any civil or administrative proceeding to satisfy any debt, lien, or obligation arising from the theft. Always submit an itemized restitution-cost statement.
• Court-record protection. Wyo. Stat. § 6-3-901(e) provides that, where a perpetrator uses the victim's identity to commit a separate crime and is convicted of that crime, the court records "shall reflect" that the person whose identity was falsely used did not commit the crime. Reference this provision when working with prosecutors and clerks to clear erroneous records.
• Wyoming Breach of Security Notification statute. Wyo. Stat. §§ 40-12-501 through 40-12-509. An individual or commercial entity conducting business in Wyoming and owning or licensing computerized data including personal identifying information about a Wyoming resident must, upon awareness of a breach, conduct a reasonable and prompt good-faith investigation, and if misuse has occurred or is reasonably likely to occur, notify affected residents in the most expedient time possible without unreasonable delay. Wyo. Stat. § 40-12-502(a). The statute specifies content requirements (toll-free number, types of PII implicated, general description of the incident, approximate date, remedial measures, advice to monitor accounts and credit reports, and any law-enforcement delay disclosure) at § 40-12-502(e).
• Definition of "personal identifying information" for breach purposes. Wyo. Stat. § 40-12-501(a)(vii) defines PII for breach-notification purposes as the first name or first initial and last name in combination with one or more of the data elements specified in Wyo. Stat. § 6-3-901(b)(iii)-(xiv) when the data elements are not redacted. Publicly available government-record information is excluded. Wyo. Stat. § 40-12-501(b).
• Breach-statute enforcement. Wyo. Stat. § 40-12-502(f) expressly authorizes the Attorney General to bring an action in law or equity; it does not itself state an express private action. The section preserves other applicable law, so evaluate any independent claim under its own elements and deadlines.
• Separate security-freeze remedy. Wyo. Stat. § 40-12-508(b) permits a civil action against a consumer reporting agency only when it intentionally or negligently releases credit information under a valid freeze and then fails both to correct the release and to give the required notice. This is distinct from the breach-notification duty in § 40-12-502.
• HIPAA safe harbor. A covered entity or business associate that complies with HIPAA's breach notification rules (45 C.F.R. Parts 160 and 164) is deemed to comply with Wyoming's statute. Wyo. Stat. § 40-12-502(h).
• Financial-institution safe harbor. A 15 U.S.C. § 6809 financial institution or 12 U.S.C. § 1752 federal credit union that complies with Gramm-Leach-Bliley's interagency notification requirements (15 U.S.C. § 6801(b)(3); 12 C.F.R. Part 364 App. B; 12 C.F.R. Part 748 App. B) is deemed to comply with Wyoming's statute. Wyo. Stat. § 40-12-502(c).
• WCPA private right. Conduct by a "covered" deceptive practice may give rise to a WCPA claim under Wyo. Stat. § 40-12-108(a) (actual damages only in individual actions), subject to the narrow scope of Wyo. Stat. § 40-12-105 ("knowingly" + "consumer transaction") and the mandatory pre-suit notice / cure regime of Wyo. Stat. § 40-12-109.
• 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 12 C.F.R. § 1022.3(i), an Identity Theft Report is a report (1) alleging identity theft with as much specificity as the consumer can provide, (2) that is a copy of an official, valid report filed by the consumer with a federal, state, or local law-enforcement agency, including the U.S. Postal Inspection Service, and (3) the filing of which subjects the filer to criminal penalties for false information. Current CFPB guidance also recognizes an FTC Identity Theft Report created through IdentityTheft.gov as a qualifying report.
• 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 and apply with each of the three nationwide CRAs. Wyoming has a parallel state credit-freeze provision in Wyo. Stat. §§ 40-12-501 through 40-12-509 (Article 5 — Credit Freeze Reports).
• Tax-related identity theft. File IRS Form 14039 only if current IRS instructions call for it (Identity Theft Affidavit) and request an IRS Identity Protection PIN.
• Law enforcement options. Local Wyoming agencies typically take identity-theft reports: city police departments (e.g., Cheyenne PD, Casper PD, Laramie PD), county sheriffs, and the Wyoming Division of Criminal Investigation (DCI) within the Office of the Attorney General. The Wyoming DCI may also coordinate multi-jurisdictional cases.
• Statute of limitations on civil claims. FCRA private actions: TWO (2) years from discovery, FIVE (5) years outside (15 U.S.C. § 1681p). WCPA: pre-suit notice within ONE (1) year of discovery / TWO (2) years of transaction; suit within ONE (1) year after notice (Wyo. Stat. § 40-12-109). Common-law tort claims (e.g., negligence, invasion of privacy): four (4) years for negligence (Wyo. Stat. § 1-3-105(a)(iv)(C)).
• Consumer Sentinel. Federal, state, and local law enforcement access reports filed at IdentityTheft.gov through the FTC's Consumer Sentinel Network — including the Wyoming AG and DCI.

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
• 12 C.F.R. § 1022.3(i) (definition of Identity Theft Report) — https://www.ecfr.gov/current/title-12/chapter-X/part-1022/section-1022.3
• Wyo. Stat. § 6-3-901 (theft of identity) — https://law.justia.com/codes/wyoming/title-6/chapter-3/article-9/section-6-3-901/
• Wyoming Restitution Statutes, Wyo. Stat. §§ 7-9-101 through 7-9-115 — https://wyoleg.gov/
• Wyoming Breach of Security Notification statute, Wyo. Stat. §§ 40-12-501 through 40-12-509 — https://wyoleg.gov/statutes/compress/title40.pdf
• Wyo. Stat. § 40-12-501 (definitions) — https://wyoleg.gov/statutes/compress/title40.pdf
• Wyo. Stat. § 40-12-502 (notice to affected persons) — https://wyoleg.gov/statutes/compress/title40.pdf
• Wyoming Consumer Protection Act, Wyo. Stat. §§ 40-12-101 through 40-12-114 — https://wyoleg.gov/
• Wyoming Attorney General — Consumer Protection and Antitrust Unit — https://attorneygeneral.wyo.gov/law-office-division/consumer-protection-and-antitrust-unit
• Wyoming Division of Criminal Investigation (DCI) — https://attorneygeneral.wyo.gov/dci
• FTC IdentityTheft.gov — https://www.identitytheft.gov/
• IRS Form 14039 only if current IRS instructions call for it (Identity Theft Affidavit) — https://www.irs.gov/identity-theft-fraud-scams/identity-theft-guide-for-individuals#form14039
• 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 Wyoming must review and customize this document before use. Laws, citations, and regulations change frequently; verify all authorities before signing or filing.