Identity Theft Affidavit
Sworn statement of identity theft - for use with creditors, credit bureaus, and law enforcement.
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IDENTITY THEFT AFFIDAVIT
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VICTIM IDENTIFICATION
Full legal name: Jordan Alex Taylor
Current address: 482 Elm Street, Apt 3B, Portland, OR 97214
Date of birth: June 12, 1985
SSN (last 4): XXX-XX-1289
Phone: +1 503 555 0118
Email: jordan.taylor@example.com
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DISCOVERY
Date of discovery: April 22, 2026
How discovered:
On 2026-04-22, I checked my credit report at annualcreditreport.com and noticed three accounts I did not open:
- Capital One Bank credit card (last 4: 1289), opened 2025-06-15.
- Discover Bank credit card (last 4: 4488), opened 2025-09-22.
- Wells Fargo Bank checking account (last 4: 7821), opened 2026-01-10.
I also received a credit-collection call (later that day) referencing one of these accounts; the collector's details matched the credit-report entries.
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FRAUDULENT ACCOUNTS AND ACTIVITY
Capital One Bank credit card #####1289 - opened 2025-06-15 in my name without my knowledge or consent. Current balance per credit report: $1,842.
Discover Bank credit card #####4488 - opened 2025-09-22 without my knowledge. Current balance: $3,650.
Wells Fargo Bank checking #####7821 - opened 2026-01-10 without my knowledge. Activity unknown.
Unauthorised inquiries (hard pulls) on credit report: 4 (between 2025-06 and 2026-01) - all on dates when I did not apply for credit.
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REPORTS FILED
Police report: Portland Police Bureau, report #PR-2026-046720, filed 2026-04-23
FTC report (identitytheft.gov): IT-2026-04-22-118432
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ACTIONS ALREADY TAKEN
Filed FTC ID-theft report at identitytheft.gov (2026-04-22), generating recovery plan.
Filed police report (2026-04-23, PPB #PR-2026-046720).
Placed 1-year fraud alerts with Experian, Equifax, TransUnion (2026-04-23).
Placed security freezes with all three credit bureaus (2026-04-24).
Notified creditors of fraud: Capital One (case #CFC-2026-44128), Discover (case #DFD-2026-77821), Wells Fargo (case #WFC-2026-118432).
Reviewed bank statements for past 12 months on legitimate accounts - no unauthorised activity.
Changed passwords on all financial accounts and email.
Monitoring credit weekly via free service (creditkarma.com / annualcreditreport.com).
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ATTESTATION
I declare under penalty of perjury that I am the victim of identity theft as described above. I did not authorise the opening of, or any charges on, the accounts listed above. I will cooperate fully with creditors and law enforcement to investigate and resolve this fraud. I understand that filing a false identity-theft report is a federal crime under 18 USC ยง1028A and various state laws.
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I, Jordan Alex Taylor, declare under penalty of perjury under the laws of the United States that the foregoing is true and correct.
_______________________________ Date: May 5, 2026
Jordan Alex Taylor
NOTARY ACKNOWLEDGEMENT (recommended, often required by creditors)
State of __________________ )
) ss.
County of __________________ )
Sworn to and subscribed before me on May 5, 2026 by Jordan Alex Taylor, who is personally known to me or proved identity to me by satisfactory evidence.
________________________________
Notary Public โ signature & seal
My commission expires: ____________________
About this template
An identity-theft affidavit is a sworn statement that triggers specific consumer rights under federal law and forms the foundation for recovery. The federal Fair and Accurate Credit Transactions Act (FACTA, amending FCRA) created strong rights for ID-theft victims: blocking of fraudulent items from credit reports (FCRA ยง1681c-2) upon submission of FTC affidavit; right to receive copies of fraud-related transaction records from creditors; right to fraud alerts and security freezes on credit reports. The recommended workflow for an ID-theft victim: (1) File FTC report at identitytheft.gov - generates recovery plan and the official FTC affidavit; (2) File police report - many creditors require it; (3) Place fraud alert (1-year initial, free) with one bureau (which notifies the other two); (4) Place security freeze (free, unlimited) with all three bureaus; (5) Notify each fraudulent-account creditor with the FTC affidavit, police report, and dispute letter; (6) Notify credit bureaus to dispute fraudulent items; (7) Monitor credit weekly via free annual reports staggered across the three bureaus. The IRS has a separate ID-theft affidavit (Form 14039) for tax-related identity theft. Identity theft can extend to medical (someone using your insurance for treatment), criminal (someone using your name when arrested), and synthetic (using your SSN with a different name) - each has its own remediation path. The FTC report is the single most important document; many creditors and bureaus accept it as authoritative for blocking, dispute, and recovery purposes. Consumer Financial Protection Bureau (consumerfinance.gov) accepts complaints about creditors that fail to honor ID-theft procedures.
When to use it
- Discovery of fraudulent accounts in your name.
- Unauthorised charges on existing accounts.
- Calls from collectors about debts you didn't incur.
- Tax-related identity theft (someone filed a return in your name).
- Medical identity theft (someone used your insurance).
- Criminal identity theft (someone gave your name when arrested).
What to include
- Victim identification (name, DOB, SSN last 4, address).
- Discovery date and method.
- List of fraudulent accounts and activity.
- Police report number.
- FTC IdentityTheft.gov report number.
- Actions already taken.
- Sworn attestation under penalty of perjury.