"Identity Theft Complaint Form" - Missouri

Identity Theft Complaint Form is a legal document that was released by the Missouri Attorney General - a government authority operating within Missouri.

Form Details:

  • Released on January 1, 2019;
  • The latest edition currently provided by the Missouri Attorney General;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Missouri Attorney General.

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Download "Identity Theft Complaint Form" - Missouri

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ERIC SCHMITT
ago.mo.gov
Identity Theft
Complaint Form
800-392-8222
MISSOURI ATTORNEY GENERAL
If you would like to file a complaint regarding Identity Theft, please complete and mail this form to:
Missouri Attorney General’s Office
Consumer Protection Unit
P.O. Box 899
Jefferson City, MO 65102
Information About Consumer
YOUR NAME
First
Last
Mi
ADDRESS
Street
City
State
Zip
County
E-MAIL
PRIMARY PHONE NO.
(
)
-
SECONDARY PHONE NO.
(
-
)
Information About Complaint
HOW DID YOU BECOME AWARE OF THE IDENTITY CRIME?
Found fraudulent charges on my credit card bill or my cell phone bill.
Received bills for an account(s) I did not open.
Found irregularities on my credit report.
Was contacted by a creditor demanding payment.
Was contacted by a bank’s fraud department about charges.
Was denied a loan or credit.
Was arrested, had a warrant issued, or a complaint filed in my name for a crime I did not commit.
Was sued for a debt I did not incur.
Was not regularly receiving bills for a legitimate account.
Was denied employment.
Had my driver’s license suspended for actions I did not commit.
Received notice of a legal action I did not file, such as bankruptcy.
Had my tax return rejected because someone filed in my name.
Received a notice of a data breach in the mail or by email.
Other
PLEASE EXPLAIN IN MORE DETAIL THE ITEM(S) YOU CHECKED ABOVE.
You may attach a separate sheet of paper if you need more space.
Page 1
Modified January 2019
ERIC SCHMITT
ago.mo.gov
Identity Theft
Complaint Form
800-392-8222
MISSOURI ATTORNEY GENERAL
If you would like to file a complaint regarding Identity Theft, please complete and mail this form to:
Missouri Attorney General’s Office
Consumer Protection Unit
P.O. Box 899
Jefferson City, MO 65102
Information About Consumer
YOUR NAME
First
Last
Mi
ADDRESS
Street
City
State
Zip
County
E-MAIL
PRIMARY PHONE NO.
(
)
-
SECONDARY PHONE NO.
(
-
)
Information About Complaint
HOW DID YOU BECOME AWARE OF THE IDENTITY CRIME?
Found fraudulent charges on my credit card bill or my cell phone bill.
Received bills for an account(s) I did not open.
Found irregularities on my credit report.
Was contacted by a creditor demanding payment.
Was contacted by a bank’s fraud department about charges.
Was denied a loan or credit.
Was arrested, had a warrant issued, or a complaint filed in my name for a crime I did not commit.
Was sued for a debt I did not incur.
Was not regularly receiving bills for a legitimate account.
Was denied employment.
Had my driver’s license suspended for actions I did not commit.
Received notice of a legal action I did not file, such as bankruptcy.
Had my tax return rejected because someone filed in my name.
Received a notice of a data breach in the mail or by email.
Other
PLEASE EXPLAIN IN MORE DETAIL THE ITEM(S) YOU CHECKED ABOVE.
You may attach a separate sheet of paper if you need more space.
Page 1
Modified January 2019
ERIC SCHMITT
ago.mo.gov
Identity Theft
Complaint Form
800-392-8222
MISSOURI ATTORNEY GENERAL
Information About Complaint (Con’t)
2 0
WHAT DATE DID YOU FIRST BECOME AWARE OF THE IDENTITY CRIME?
/
/
MM / DD/ YYYY
2 0
WHEN DID THE FRAUDULENT ACTIVITY BEGIN?
/
/
MM / DD/ YYYY
WHAT IS THE FULL NAME, ADDRESS & OTHER IDENTIFYING INFORMATION THAT THE FRAUDULENT ACTIVITY WAS MADE UNDER?
Name
Middle
First
Last
Address
Street
City
State
Zip
County
PLEASE LIST ALL FRAUDULENT ACTIVITY THAT YOU ARE AWARE OF TO DATE, WITH THE LOCATIONS AND ADDRESSES OF WHERE
THE FRAUDULENT APPLICATIONS OR PURCHASES WERE MADE. LIST IN CHRONOLOGICAL ORDER, IF POSSIBLE. PLEASE BE
CONCISE AND STATE THE FACTS.
You may attach copies of supporting documents/notes you have.
Page 2
Modified January 2019
ERIC SCHMITT
ago.mo.gov
Identity Theft
Complaint Form
800-392-8222
MISSOURI ATTORNEY GENERAL
Information About Complaint (Con’t)
TO THE BEST OF YOUR KNOWLEDGE AT THIS POINT, WHAT IDENTITY CRIMES HAVE BEEN COMMITTED?
Making purchase(s) using my credit cards or credit card numbers without authoriziation.
Opening new credit card accounts in my name.
Opening utility and/or telephone accounts in my name.
Unauthorized withdrawals from my bank accounts.
Opening new bank accounts in my name.
Taking out unauthorized loans in my name.
Unauthorized access to my securities or investment accounts.
Obtaining government benefits in my name.
Obtaining employment in my name.
Obtaining medical services or insurance in my name.
Evading prosecution for crimes committed by using my name or committing new crimes under my name.
Check fraud.
Passport/visa fraud.
Filing a tax return in my name.
Obtaining services or credit in my child or my foster child’s name.
Other (please explain)
DO YOU HAVE ANY INFORMATION ON A SUSPECT IN THIS IDENTITY CRIME CASE? IF SO, PLEASE PROVIDE AS MUCH INFORMATION
AS POSSIBLE ABOUT THE SUSPECT, INCLUDING THE SUSPECT’S FULL NAME, PHONE NUMBER AND ADDRESS.
Suspect’s Name
Middle
First
Last
Address
Street
City
State
Zip
County
HOW DO YOU BELIEVE THE IDENTITY CRIME OCCURRED?
Page 3
Modified January 2019
ERIC SCHMITT
ago.mo.gov
Identity Theft
Complaint Form
800-392-8222
MISSOURI ATTORNEY GENERAL
Information About Complaint (Con’t)
PLEASE LIST ANY GOVERNMENT DOCUMENTS FRAUDULENTLY OBTAINED IN YOUR NAME.
(DRIVER’S LICENSES, SOCIAL SECURITY CARDS, ETC.)
HAVE YOU CONTACTED THE FOLLOWING ORGANIZATIONS & REQUESTED A FRAUD ALERT TO BE PUT ON YOUR ACCOUNT?
(Check all that apply.)
Equifax. Date?
TransUnion. Date?
Experian. Date?
Your bank(s). Names of bank(s):
Social Security Administration
Department of Motor Vehicles.
Other:
HAVE YOU REQUESTED A CREDIT FREEZE WITH A CREDIT REPORTING AGENCY?
HAVE YOU REQUESTED A CREDIT REPORT FROM EACH OF THE THREE CREDIT BUREAUS?
(Check all that apply.)
Equifax
If you have any reports, please attach a copy of each to this form.
TransUnion
Please keep your original documents in a safe place. Send
Experian
ONLY COPIES to the Attorney General’s Office at this time.
Your Verification
BY FILING THIS COMPLAINT, I UNDERSTAND THAT:
The Attorney General is not my private attorney, but enforces state consumer protection laws;
I would be willing to testify in court to the fact stated in this complaint; and
In accordance with Missouri law, consumer complaints are “public records, ” subject to public disclosure upon request. My complaint, including
my name, address and related documents, may be provided pursuant to a Sunshine Law request.
I ATTEST TO THE ACCURACY OF STATEMENTS MADE IN THIS COMPLAINT:
YOUR SIGNATURE
2 0
DATE
/
/
MM / DD/ YYYY
Page 4
Modified January 2019
Page of 4