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

The Identity Theft Affidavit (REV-1196) is an important document for individuals who have fallen victim to identity theft. This guide provides a clear, step-by-step process to help you fill out the form online, ensuring your information is submitted accurately and effectively.

Follow the steps to complete the Identity Theft Affidavit online.

1. Press the ‘Get Form’ button to access the Identity Theft Affidavit and open it in your preferred editor.
2. In Part I of the form, enter the tax year(s) impacted by the identity theft and/or the date the incident occurred if known. Provide the last Pennsylvania tax year return filed, using 'NRF' if you were not required to file.
3. Fill in the last four digits of your Social Security Number, your last name, first name, and middle initial.
4. Complete your current mailing address, including city, state, and ZIP code, along with the address used on your last Pennsylvania tax return.
5. Input your daytime telephone number and indicate the best time(s) to reach you at home, work, and/or cell.
6. In Part II, respond to the questionnaire by indicating whether you filed an identity theft report with the police, and attach a copy of the report if applicable.
7. Continue through the questionnaire to state if you requested a consumer reporting company to place a fraud alert on your credit report and whether you reported the incident to the Social Security Administration and the Internal Revenue Service.
8. Provide a detailed explanation of the identity theft incident in Part III, attaching additional sheets if necessary.
9. Sign and date the form in Part IV, ensuring the signature is made after printing the document.
10. After completing the form, review your entries for accuracy, then save your changes, download, print, or share the completed form as needed.

Start filling out your Identity Theft Affidavit online today to protect your information.