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Identity Theft Self-Reporting Form
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Reportee / Victim Information
Type of account opened (credit card, electric, gas, phone, etc.):
Name of Company
Phone Number of Company
If you spoke to someone at the company, what is their name and phone number:
What is the account number:
What is the fraudulent dollar amount:
When was the account opened:
Is the fraudulent account for a specific address (such as a cable, phone, or electric bill):
If so, what address?
Do you know who used your information?
If so, what is their name, address, and contact information:
Are they related to you or an acquaintance:
I have read the statement below and will supply the information. Type yes in the space provided.
You MUST have copies of your credit history and any associated paperwork to include credit card statements, loan documentation, etc. to support the claim of your personal information being used without your authorization or consent. You MUST know what personal information was used at the time of submitting this online form. All forms can be emailed to addresses listed below.
Mail to: Sherman Police Department, 317 S. Travis, Sherman, TX 75090, or
Fax to: 903-892-7188, or
Email to: email@example.com
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