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Ftc identity theft form Average time to complete 10 minutes Identity Theft Victim s Complaint and Affidavit A voluntary form for filing a report with law enforcement and disputes with credit reporting agencies and creditors about identity theft-related problems. Visit ftc.gov/idtheft to use a secure online version that you can print for your records. Before completing this form 1. Date Signed mm/dd/yyyy Your Affidavit If you do not choose to file a report with law enforcement you may use this form as an Identity Theft Affidavit to prove to each of the companies where the thief misused your information that you are not responsible for the fraud. Visit ftc*gov/idtheft to use a secure online version that you can print for your records. Before completing this form 1. Place a fraud alert on your credit reports and review the reports for signs of fraud. 2. Close the accounts that you know or believe have been tampered with or opened fraudulently. About You the victim Now My full legal name My date of birth My Social Security number -- My driver s license My current street address First Middle Last Suffix mm/dd/yyyy State Number Number Street Name Apartment Suite etc* I have lived at this address since Leave 3 blank until you provide this form to someone with a legitimate business need like when you are filing your report at the police station or sending the form to a credit reporting agency to correct your credit report. My daytime phone My evening phone My email City Zip Code Country At the Time of the Fraud Skip 8 - 10 if your information has not changed since the fraud. My address was The Paperwork Reduction Act requires the FTC to display a valid control number in this case OMB control 3084-0047 before we can collect or sponsor the collection of your information or require you to provide it. Victim s Name Phone number Page 2 Declarations 11 I did OR did not authorize anyone to use my name or personal information to obtain money credit loans goods or services or for any other purpose as described in this report. 12 I receive any money goods services or other benefit as a result of the events described in this report. 13 I am OR am not willing to work with law enforcement if charges are brought against the person s who committed the fraud. About the Fraud I believe the following person used my information or identification documents to open new accounts use my existing accounts or commit other fraud. Name Address Enter what you know about anyone you believe was involved even if you don t have complete Phone Numbers Additional information about this person 14 and 15 gained access to your information or which documents or information were Attach additional used sheets as needed* Documentation I can verify my identity with these documents A valid government-issued photo identification card for example my driver s license state-issued ID card or my passport. If you are under 16 and don t have a photo-ID a copy of your birth certificate or a copy of your official school record showing your enrollment and legal address is acceptable.

Affidavit domicile form AFFIDAVIT OF DOMICILE STATE OF ) )SS: COUNTY OF ) , being duly sworn deposes and says that he/she resides at , State of and is executor/administrator of the estate of deceased, who died on the day

Hi form divorce INSTRUCTIONS UNCONTESTED DIVORCE PACKET WITH CHILDREN (for the Island of Kaua i) WHO CAN FILE FOR DIVORCE? In order to file a divorce action in the Family Court of the Fifth Circuit (on Kaua i), you

Do it yourself affidavit proce... LUEG:SW SP SWQMP ..... http://www.sandiegocounty.gov/pds/docs/pds659.pdf. ... for Disturbed Areas of 1 Acre or Less Building Division. PDS 659. Available ...

Affidavit of change of denomin... ALASKA UNIFIED CERTIFICATION PROGRAM (AUCP) Disadvantaged Business Enterprise (DBE) Print Form ANNUAL 'NO CHANGE' AFFIDAVIT , owner of I (owner name) (firm name) affirm that there have been

Long form affidavit florida el... Application for Certification of Communications Services Database DR-700012 R. 05/11 Rule 12A-19.100 Florida Administrative Code Please Read Instructions First Check one: Application for certification

Michigan affidavit of parentag... APPLICATION FOR A CERTIFIED COPY MICHIGAN AFFIDAVIT OF PARENTAGE RECORD NOTE: The Michigan Vital Records office has Affidavit of Parentage records that were filed in the Central Paternity Registry

Dr 150 form AS 25. 30. 380 e IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT I CASE NO. CHILD CUSTODY JURISDICTION AFFIDAVIT say on oath or affirm under penalty of perjury that The following children are the subject of the present custody proceedings Child s Name Place of Birth Present Address since Prior Residences for past 5 years dates Birthdate Sex Who Has Custody Person Child Lived With Name Current Address City State Relationship to / Page 1 of 3 DR-150 3/03 cs CHILD CUSTODY AFFIDAVIT AS 25. If you believe that disclosure of some of the information on this form would jeopardize your health safety or liberty or that of your children you are not required to serve a copy of this form on the other party. Instead file this form with the court along with court form DR-151 available at the clerk s office. 30. 380 2. Have you participated as a party a witness or in another capacity in another proceeding concerning the custody of any of the above children or visitation with them Yes No If yes describe the previous child custody determination Name of Court Case Number Court s Decision Date 3. Do you know of a proceeding that could affect the current proceeding including a proceeding relating to domestic violence protective orders termination of parental rights adoption or enforcement of a court order If so describe Name of Court Nature of Proceeding the above children or claims to have the right to physical custody legal custody or visitation If so list each person s name and address and what the person claims I swear or affirm under penalty of perjury that my statements in this affidavit are true to the best of my knowledge and belief* Signature Subscribed and sworn to or affirmed before me at. on Alaska SEAL Clerk of Court Notary Public or other person authorized to administer oaths. My Commission Expires I certify that on a copy of this affidavit was mailed to the other party in this case list name Note Each party has a continuing duty to inform the court of any other court proceeding in this state or any other state concerning any of the children listed above. If you believe that disclosure of some of the information on this form would jeopardize your health safety or liberty or that of your children you are not required to serve a copy of this form on the other party. Instead file this form with the court along with court form DR-151 available at the clerk s office. 30. 380 2. Have you participated as a party a witness or in another capacity in another proceeding concerning the custody of any of the above children or visitation with them Yes No If yes describe the previous child custody determination Name of Court Case Number Court s Decision Date 3. Do you know of a proceeding that could affect the current proceeding including a proceeding relating to domestic violence protective orders termination of parental rights adoption or enforcement of a court order If so describe Name of Court Nature of Proceeding the above children or claims to have the right to physical custody legal custody or visitation If so list each person s name and address and what the person claims I swear or affirm under penalty of perjury that my statements in this affidavit are true to the best of my knowledge and belief* Signature Subscribed and sworn to or affirmed before me at.

Affidavit of best interest for... You must use black ink to fill out this form. Your Name: Mailing Address: Telephone: Message phone: NOTE: If for any reason you do not wish the other party to know your physical address, you must

Copy of affidavit of financial... Name: Mailing Address: City, State, Zip Code: Daytime Phone Number: Evening Phone Number: Representing: Self Petitioner Respondent State Bar Number: ARIZONA SUPERIOR COURT, COUNTY OF COCHISE Case

Affidavit of employment verifi... EMPLOYMENT VERIFICATION FORM ******************************************************************* Print Form To be completed by the requesting organization or DHS official recording a verbal request:

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