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(Middle) (Last) (Jr., Sr., III) 4. Social Security Number: (month / day / year) 3. Driver s License or ID card number: State 4. Current address: City State Zip Code 5. Telephone numbers: Daytime: Evening: Cell: How the Fraud Occurred: Check all items that apply: 6. I did not authorize anyone to use my name or personal information to obtain any DMV license, registration or service. 7. My identification documents (i.e. birth certificate, Social Security card, driver s license) w.
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