"Credit Report Request Template for Deceased"

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Credit Report Request for the Deceased
Sent credit report request via (include all that apply):
e-mail
fax
mail (certified return receipt requested no.) ____________________
To (
: _____________________________________________________
Name of Company)
Address: ________________________________________________________________
Other Contact Info: ________________________________________________________
Date of Request: _________________________________________________________
Your name:______________________________________________________________
Address: ________________________________________________________________
Phone Number
__________________________________________
(daytime/evening/cell):
As the ___________________
I am notifying you that the following
(relationship to deceased),
person died.
Name of deceased: __________________________________________
Date of death: _______________________________________________
Date of birth: ________________________________________________
Location of birth: _____________________________________________
Social Security number of deceased: _____________________________
Five year address history
(most current one first): ______________________
___________________________________________________________________
I would like to make the following requests:
____ I request a current copy of (name of deceased)'s credit report be mailed to me at my address
listed above.
____ I request that the following notice be placed on (name of deceased)'s credit report:
"Deceased - Do not issue credit."
____ I request that the following notice also be added to this alert: "If an application is made for
credit, notify the following person(s) immediately: __________________________________
______________________________________(list the next surviving relative, executor/trustee of
the estate and/or local law enforcement agency- noting the relationship)."
Signed:
ITRC Letter Form 117-1
Page 1
Credit Report Request for the Deceased
Sent credit report request via (include all that apply):
e-mail
fax
mail (certified return receipt requested no.) ____________________
To (
: _____________________________________________________
Name of Company)
Address: ________________________________________________________________
Other Contact Info: ________________________________________________________
Date of Request: _________________________________________________________
Your name:______________________________________________________________
Address: ________________________________________________________________
Phone Number
__________________________________________
(daytime/evening/cell):
As the ___________________
I am notifying you that the following
(relationship to deceased),
person died.
Name of deceased: __________________________________________
Date of death: _______________________________________________
Date of birth: ________________________________________________
Location of birth: _____________________________________________
Social Security number of deceased: _____________________________
Five year address history
(most current one first): ______________________
___________________________________________________________________
I would like to make the following requests:
____ I request a current copy of (name of deceased)'s credit report be mailed to me at my address
listed above.
____ I request that the following notice be placed on (name of deceased)'s credit report:
"Deceased - Do not issue credit."
____ I request that the following notice also be added to this alert: "If an application is made for
credit, notify the following person(s) immediately: __________________________________
______________________________________(list the next surviving relative, executor/trustee of
the estate and/or local law enforcement agency- noting the relationship)."
Signed:
ITRC Letter Form 117-1
Page 1
Note: This request is being sent via certified, return receipt request mail.
Attachments:
____ Death Certificate (or copy) - required
____ Power of Attorney - if necessary
____ Proof that requester is Executor or Trustee of estate - if appropriate
____ Proof of relationship - if necessary
ITRC Letter Form 117-1
Page 2
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