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North Dakota Attorney General Wayne Stenches Office of Attorney General ID Theft Affidavit Victim Information 1. Full Legal Name: First: Middle: Last: Jr/Sr/III: 2. (If different from above) When.

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How to fill out the Identity Theft Affidavit online

Filling out the Identity Theft Affidavit is a crucial step in reporting and resolving identity theft. This guide provides clear, step-by-step instructions on how to complete the affidavit online, ensuring that you have the support you need during this process.

Follow the steps to complete the Identity Theft Affidavit effectively.

  1. Press the ‘Get Form’ button to access the Identity Theft Affidavit and open it in your preferred editor.
  2. Begin by entering your full legal name in the designated field. Include any other name you were known by at the time the identity theft occurred, if applicable.
  3. Fill in your date of birth and social security number. Ensure this information is accurate, as it is essential for identity verification.
  4. Provide your driver's license number or personal identification number along with your current address. List the city, state, and ZIP code clearly.
  5. Indicate how long you have lived at your current address and, if it differs from your current address, provide the address where the events occurred.
  6. Submit your daytime and evening telephone numbers, including area codes.
  7. In the section detailing how the fraud occurred, check all applicable reasons that describe your situation.
  8. If known, provide the names and contact information of any individuals who used your information to commit fraud. Additionally, describe how the fraud occurred.
  9. Complete the Victim's Law Enforcement Actions section by indicating your willingness to assist in the prosecution and your authorization for law enforcement to use this information.
  10. Fill out any details regarding your interaction with law enforcement, including agency names, report dates, and report numbers.
  11. Review the Documentation Checklist and attach any necessary documents, ensuring to check 'Yes' or 'No' as applicable.
  12. Finally, sign the affidavit in the required section, noting that your signature must be notarized.
  13. After completing the form, save changes and choose to download, print, or share the affidavit as needed.

Complete your Identity Theft Affidavit online today to initiate the theft reporting process.

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DA 5789-R 2011 DA 5790-R 2008 DA 5841 2005 DA 5914 2002

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Submitting Form 14039-B 2. BY FAX: • If you received a notice or letter from the IRS related to this issue and it provides a FAX number, you should send this completed form there. If no FAX number is shown on the notice or letter, please follow the mailing instructions on the notice or letter.

An Identity Theft Affidavit is a document used by victims of identity theft to prove to businesses that their personal information was used to open a fraudulent account. This document includes personal information as well as a formal statement about the facts surrounding the identity theft.

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.

How to Complete and Submit Form 14039. Explain your issue and how you discovered that your identity had been stolen in Section B. Attach any supporting documentation, such as a notice you received from the IRS, and submit it along with the form. You can't electronically file the IRS Identity Theft Affidavit.

An Identity Theft Affidavit is a document used by victims of identity theft to prove to businesses that their personal information was used to open a fraudulent account. This document includes personal information as well as a formal statement about the facts surrounding the identity theft.

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.

Dear Sir or Madam: I am a victim of identity theft. I recently learned that my personal information was used to open an account at your company. I did not open or authorize this account, and I therefore request that it be closed immediately.

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