Letter Form 115-1
Letter Forms for When You Know the Imposter

There are three ITRC Letter Forms for “When You Know the Imposter.”

• Letter Form 115-1: A Letter from the Victim to the Credit Issuer when the imposter will not cooperate.
   
• Letter Form 115-2: A Letter to be written by the Imposter accepting responsibility for accounts or charges.
   
• Letter Form 115-3:   A Letter to be used when both parties privately reach an agreement with each other to resolve the case.

These Forms are suggestions only and should not take the place of forms or letters provided by your attorney, law enforcement, or creditors. Letters should be mailed certified, return receipt requested.

Please DO NOT send any letter forms or documentation to the ITRC as we cannot clear the fraud for you.

Letter Form 115-1: Letter from victim to credit issuer

This form may be used when the imposter will not cooperate and will not sign Form Letter Two (Letter Form 115-2). Send a separate form to each creditor. Keep a copy for yourself.

Affidavit of Fact:

Victim Information

My full legal name is:_____________________________

When the events described in this affidavit took place, I was known as:

_________________________________(If different from above)

My birth date is (day/month/year): ____________________

My Social Security number is ___-__-____

My driver’s license or identification card number is:

State________ #________________

My current address is:

Street:___________________

City:_____________________

State:_________________

Zip Code:____________

I have lived at this address since ________(month/year)

When the events described in this affidavit took place, my address was:

Street:___________________

City:_____________________

State:_________________

Zip Code:____________

I lived at that address from ______ until ______(month/year)

Phone numbers:

Daytime: (____)___________

Evening: (_ __)___________

Cell: (____)_________

My e-mail address is _________________________

How the Fraud Occurred (Check all that apply):

___ I did not authorize anyone to use my name or personal information to seek the money, credit, loans, goods or services described in this report.

___ I did not receive any benefit, money, goods, or services as a result of the events described in this report.

___ My identification documents (i.e. credit cards; birth certificate; driver's license; Social Security card, etc.)  were stolen  were lost on or about _____________(day/month/year)

___ I have proof that the following person(s) used my information (for example, my name, address, date of birth, existing account numbers, Social Security number, mother’s maiden name, etc.) or identification documents to obtain money, credit, loans, goods, or services without my knowledge or authorization: (only fill out if you are certain)

Name1: ___________________________

Address: __________________________

Phone: ___________________________

Additional (i.e. relationship)_______________________________________

Name2: ___________________________

Address: __________________________

Phone: ___________________________

Additional (i.e. relationship)_______________________________________

A report has been made with the following police/sheriff’s department

Name of agency: __________________________________________

Name of investigator if known: _______________________________

Contact information for law enforcement: _______________________

If you are unable to obtain a report or report number from the police, please indicate that by checking here. (__)

_______________________________
Signature of victim

_____________
Date of Signing 

I declare under penalty of perjury that this declaration is true and correct to the best of my knowledge.  Knowingly submitting false information on this affidavit could subject you to criminal prosecution for perjury.

Have one witness (non-relative) sign below that you completed and signed this declaration.)

____________________________
Witness Name Printed:

____________________________
Witness Signature

____________________
Date of Signing

____________________
Witness Phone Number

(Have this form notarized)

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Copyright February 2007, Identity Theft Resource Center®, all rights reserved.
Written by Linda Foley, assisted by Mari Frank, Esq.
P.O. Box 26833, San Diego CA 92196
Email: itrc@idtheftcenter.org

Resource material of the Identity Theft Resource Center: http://www.idtheftcenter.org/
The information in this publication is not to be considered legal or psychological advice. This information is a resource for you and has been helpful for other victims in similar situations. If you have any legal questions or concerns, you should consult with a consumer law attorney.  
 
Fact Sheet 115  When you Personally Know the Identity Theif