Name phone number page 1 icms # id theft affidavit victim information victim information (1) my full legal name is (first) (middle) (last) (jr., sr., ) (2) (if different from above) when the events described in this affidavit took place, i was...
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North dakota attorney general wayne stenehjem office of attorney general id theft affidavit victim information 1. full legal name: first: middle: last: jr/sr/: 2. (if different from above) when the events described in this affidavit took place, i...
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Address on last tax return filed (check here if you are not required to file a tax identity theft issues to the irs so that the irs may document situations where please refer to the ftc's website at http://.ftc.gov (keyword "identity
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Instructions for completing the id theft affidavitto make certain that you do not become responsible for any debts incurred by an identity thief, you must prove to each of the companies where accounts were opened or used in your name that you...
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Form 14039 (april 2016) department of the treasury internal revenue service omb number 15452139 identity theft affidavit complete this form if you need the irs to mark an account to identify questionable activity. section a check the following...
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Formulario 14039 (sp) abril de 2009 departamento del tesoro servicio de impuestos internos declaraci n jurada sobre el robo de identidad n mero de omb 1545-2139 por favor, complete y presente este formulario si usted es v ctima o posible v ctima...
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Telecheck forgery/identity theft affidavit account holder first name middle initial account holder last name current address (street, city, state, zip code) joint account holder last name home telephone no. joint account holder first name daytime...
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Please complete, initial and date each page of this form and return within 15 days to avoid processing delays. you must include a copy of your police report and supporting documents showing that you lived at an address other than where and when...
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