IDENTITY THEFT VICTIM’S FRAUDULENT ACCOUNT INFORMATION REQUEST Made pursuant to California Financial Code 22470, Civil Code 1748.95 and Penal Code 530.8To Fax From Account Number Reference Number I am formally disputing an account that I have learned has been opened or applied for with you. I did not open or apply for this account and have not authorized anyone else to do so for me. You may consider this account to be fraudulent. Below is my identifying information. I have filed a report with my local police department and a copy is attached. Under California law, all credit grantors and utilities must provide information relating to fraudulent accounts opened in an identity theft victim’s identity, including a copy of the application and a record of the charges associated with the accountA copy of the relevant California law is enclosed. In most cases, the account information must be provided free of charge within 10 business days of your receipt of the police report and the victim's identifying information. The victim is generally permitted to authorize your release of the account information to a specified law enforcement officer. I am designating and the detective listed below as additional recipients of all account information and documents. I authorize the release of all account documents and information to the law enforcement officer designated. I am requesting the following: Statements Payments/Charge Slips Investigator’s Summary Delivery addresses Any other documents associated with the account All records of phone numbers used to activate the account or used to access the account Name Social Security Number Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneFax Employer Employer PhoneDesignated Police Department Designated Investigator Report Number SignatureDate MM slash DD slash YYYY