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Get 72068 2020-2024

Marriage birth social security or passport Does the victim know the imposter Is the imposter related to the victim If yes what is the relationship City/County/State where the imposter may be located PLEASE COMPLETE THE SECOND PAGE OF THIS FORM HSMV Form 72068 Rev 07/11 Page 1 of 2 Possible Imposter s Information Name of Possible Imposter List any alias name date of birth and social security number of possible imposter. STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES DIVISION OF MOTORIST SERVICES BMC Fraud Section Use Only Fraud Case Number Date Received Fraud Investigation Requests This form is to be completed ONLY when a victim is affected by driver license or identification card fraud. If your complaint is in regard to a citation you must contact the court where the citation was issued to resolve the matter. Date of Complaint Time of Complaint Office Number AM PM Address DHSMV Representative s Name and ID Number Complaint originated from Victim Law Enforcement Other If the complaint originated from Law Enforcement or Other please list the contact information to include agency officer s name address and telephone number. Has any formal complaint been made with any Law Enforcement or other government entity in connection with this complaint Yes No If yes please list the agency name officer s name case number and contact information* Has the victim had any identification documents stolen or lost List the items and approximate date of loss Would the victim like to have his/her record flagged Victim/Complainant Information Name First Middle Last Maiden or Mother s Maiden Name Current or Last Known Mailing Address Florida DL/ID Number OOS DL/ID Number Telephone Home Work Email Address Cell Social Security Number Types of DL/ID Fraud Florida DL/ID Fraud Counterfeit Address Fraud Out of State Certificate Fraud Must provide copy of photo ID birth certificate social security card and sample signature. Also list any other name and DL involved include other state s DL information Complaint Please give as many details as possible Mail or Email the completed form to Division of Motorist Services / Bureau of Motorist Compliance Email Fraud flhsmv*gov Mail Fraud Section Room A327 Neil Kirkman Building Tallahassee Florida 32399-0570. STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES DIVISION OF MOTORIST SERVICES BMC Fraud Section Use Only Fraud Case Number Date Received Fraud Investigation Requests This form is to be completed ONLY when a victim is affected by driver license or identification card fraud. If your complaint is in regard to a citation you must contact the court where the citation was issued to resolve the matter. If your complaint is in regard to a citation you must contact the court where the citation was issued to resolve the matter. Date of Complaint Time of Complaint Office Number AM PM Address DHSMV Representative s Name and ID Number Complaint originated from Victim Law Enforcement Other If the complaint originated from Law Enforcement or Other please list the contact information to include agency officer s name address and telephone number.

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