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  • Identity Theft Affidavit (rev-1196) - Pa Department Of Revenue

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NATURE Under penalty of perjury, I declare that, to the best of my knowledge and belief, the information entered in this form is true, correct, complete and made in good faith. Signature Reset Entire Form SIGN AFTER PRINTING PREVIOUS PAGE Date MMDDYYYY PRINT.

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The ID Theft Affidavit provides a model form that can be used to report information to many companies, simplifying the process of alerting companies where a new account was opened in the victim's name.

Part One — the ID Theft Affidavit — is where you report general informa- tion about yourself and the theft. Part Two — the Fraudulent Account Statement — is where you describe the fraudulent account(s) opened in your name. Use a separate Fraudulent Account Statement for each company you need to write to.

Write to the Credit Bureaus Send copies of your police report and completed ID Theft Affidavit. Remind the credit bureaus that they must block or remove any information that you, as an identity theft victim, say is a result of the theft. Send your letters by certified mail, return receipt requested.

It's known as IRS Form 14039. Keep in mind that identity theft victims can complete this form as a preventive measure if they don't know whether someone used their information to file a tax return but they know they're a victim of identity theft.

This form should be used for all unauthorized charges against Credit or Debit cards. This form must be signed and notarized; and requires a case number from a current police report filed against the unauthorized activity.

The FTC provides an ID Theft Affidavit to help victims of identity theft quickly and accurately dispute new unauthorized accounts. It is especially helpful in cases where consumers are unable to file or obtain a police report.

Filing Form 14039, Identity Theft Affidavit It can be completed online, printed and attached to a paper tax return for mailing to the IRS. Or taxpayers may complete the form online at the Federal Trade Commission and the FTC will electronically transfer the Form 14039 – but not the tax return – to the IRS.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232