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Olympia Police Department Xxx Identity Theft/Credit Card Fraud Report Xxx (Department Use Only) Case #_________________ Olympia Police Department xxx Identity Theft/Credit Card Fraud Report xxx If you either live within the boundaries of the City of Olympia or the crime occurred within the boundaries of the City of Olympia and you do not have any information on possible suspects, you may use this form to report identity theft and/or fraudulent use of a credit card. Provide as much data as possible and attach all supporting documentation (such as copies of account activity from your bank or credit card company and/or an Affidavit of Forgery) that is evidence that you have been the victim of a crime. Your report will be reviewed by OPD, and, if it meets legal requirements, it will be assigned a case number and returned to you by mail. If you do not receive a response within 30 days, please call (360)753‐8300. Do not leave any field marked by an asterisk (*) blank, as that information – along with the supporting documentation – is required to meet legal reporting requirements. Definition Examples ♦ No person may knowingly obtain, possess, use, or ♦ Someone obtains a credit card using your Identity Theft transfer a means of identification or financial SSN or obtains phone service using your information of another person, living or dead, with personal information. RCW 9A.60.020 the intent to commit, or to aid or abet, any crime. ♦ Someone uses your credit card and/or ♦ Fraudulent use of someone’s existing credit card. card number for purchases. Incident Details: Location of Crime:* Date of Crime:* Complainant/Victim Information: Name:* DOB:* Last First Middle Street Address:* City:* State:* Zip:* Home Phone: Cell Phone: Work Phone: Drivers License or ID #: State: Email Address: Please provide at least one phone number and/or email address. What identity crimes have been committed? (Check all that apply.) Passport/Visa fraud. Check Fraud Unauthorized withdrawals from my bank accounts. Getting unauthorized loans in my name. New credit card accounts opened in my name. Opening new bank accounts in my name. Opening utility and/or telephone accounts in my Making purchase(s) using my credit card(s) or credit name. card number(s) without authorization. Obtaining employment in my name. Obtaining government benefits in my name. Evading prosecution for crimes committed by using Unauthorized access to my securities or investment my name or committing new crimes under my name. accounts. Other: (Department Use Only) Case #_________________ How do you believe this crime occurred?* Please be specific and use as much detail as possible. I certify(or declare) under penalty of perjury under the laws of the State of Washington that the foregoing and the accompanying reports/copies of documents and the information contained therein are true, correct, and accurate (RCW 9A.72.085). Signature: __________________________________________________________ Date: ______________________ When you have completed the form, please print it out and mail along with all supporting documents to: Olympia Police Department, ATTN: Detectives, P.O. Box 1967, Olympia, WA 98507‐1967. Once we have received your report, it will be reviewed to insure the elements of Credit Card Fraud/Identity Theft are met. A copy of this report will be mailed back to you once it has been processed. Please retain it for your records. If you have questions you can call the Olympia Police Detective Office at 360‐753‐8400. Olympia Police Department Use Only Your report form has been accepted and filed in our records office under the above case number. You do not meet the residency/crime location requirements to file a report with OPD. Please contact your home jurisdiction to make a report. Your report form has not been filed due to insufficient information to determine that any law has been violated or a crime has been committed. Your report form indicates that you have been the victim of a crime other than ID theft/fraud that requires a different type of police report. Contact the dispatch center at 360‐704‐2740 to report the incident. Received by: ______________________________________________________ Date __________________________ .
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