Identity Theft Self-Reporting Form

Identity Theft Self-Reporting Form
In order to conduct a thorough investigation of your case, certain information is needed. All of the information required can be obtained by you and it will assist in reducing the lengthy process of a detective obtaining the information. IF YOU DO NOT PROVIDE THE REQUIRED INFORMATION, YOUR CASE WILL NOT BE ASSIGNED FOR INVESTIGATION.
Reportee/Victim Information
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Fraudulent Information
Type of account opened (credit card, electric, gas, phone, etc.):
Name of company:
Phone number of company:
Please enter a valid phone number.
Address of company:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If you spoke to someone at the company, what is their name and phone number:
What is the fraudulent dollar amount:
What is the account number:
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 the address listed below.

Mail to: Sherman Police Department, 2600 West Travis, Sherman, TX 75092, or

Fax to: 903-892-7188, or

Email to: hollyg@cityofsherman.com; alexm@cityofsherman.com; juliam@cityofsherman.com
Please verify that you are human*
Should be Empty: