For Department Use Only

Identity Theft Report Assign To Police Beat CP Beat RD No.

Oakland Police Department
455 7th Street, Oakland, CA 94607 Crime (Section-Subsection Code Classification

☞ IT IS A MISDEMEANOR TO MAKE A FALSE REPORT

OF A CRIME (SEC. 148.5 CALIF. PENAL CODE)

Victim Information (Please Complete All Boxes / Type or Print in Non-Erasable Black Ink)
Last, First, Middle DOB Age Race Sex
Victim
Home Address City State / Zip Home Phone DL Number State

Work Address City State / Zip Work Phone

Other Contact Information: Other phone, cell phone, pager, mail address

Report Type (PC Section / Description) Date Reported Time Day

530.5(a) PC / Identity Theft
Location of Incident Date Started Time Day

Location of Suspect (if known) Date of Last Activity Time Day

Do you know of any person or have any other information that may indicate who committed this crime? ❏ NO ❏ YES (If yes, list below)

Suspect Information (Please Complete All Boxes / Type or Print in Non-Erasable Black Ink)
Last, First, Middle DOB Age Race Sex HGT WGT Hair Eyes
Suspect
Last, First, Middle DOB Age Race Sex HGT WGT Hair Eyes
Suspect
AKA / Nickname(s) Relationship to Victim

Home Address City State / Zip Home Phone DL Number State

Work Address City State / Zip Work Phone

COMPROMISED INFORMATION ❏ Mother’s Maiden Name ❏ Savings Account Number ❏ Other

❏ Name
❏ Driver’s License Number ❏ Credit Card Number
❏ Address
❏ Social Security Number ❏ Debit Card Number
❏ Date of Birth
❏ Checking Account Number ❏ ATM Card Number
UTILIZED FOR ❏ Mortgage Loan ❏ Driver’s License Fraud ❏ Other
❏ In-Store Instant Credit
❏ Cellular Phone Account ❏ Employment
❏ Credit Card Application
❏ Utilities ❏ Store/Retail Purchase
❏ Automobile Purchase
❏ Fraudulent Bank Account ❏ Internet / Mail Order Purchase

How Was Information Obtained? ❏ Unknown ❏ Lost ❏ Stolen ❏ Other

If Theft / Burglary, from? ❏ Mail ❏ Residence ❏ Vehicle ❏ Business ❏ Purse/Wallet ❏ Other
If Lost/Theft/Burglary, In What City? _____________________________________ Police Report Taken? ❏ No ❏ Yes. Agency/Case # ______________________________
If unknown, have you recently obtained a loan or applied for credit? ❏ No ❏ Yes. Where? _________________________________________________________________
*Have you contacted any of the three major credit reporting companies?❏ No ❏ Yes. Which? ______________________________________________________________
Have you obtained copies of your credit reports? ❏ No ❏ Yes. Which? ___________________________________________________________________________________
**Have you placed a fraud alert on your credit? ❏ No ❏ Yes. Which? _____________________________________________________________________________________
Additional fraud accounts listed on credit report(s)? ❏ No ❏ Yes. Which? _______________________________________________________________________________
Identity theft information flyer given ❏ No ❏ Yes

Attach the following:

• Synopsis of incident in chronological order (see reverse).
• Photocopy of one of the following: California Drivers License, California ID, Passport Picture ID, or Other
Picture ID
KEEP A PHOTOCOPY OF COMPLETED REPORT WITH YOUR RECORDS
Signature Date (Month/Day/Year)

* The three major credit reporting companies are listed on the back.
** Instructions for placing a fraud alert are listed on the back.

TF 3253 (3/07)
Oakland Police Department IDENTITY THEFT REPORT Page 2

REPORT OF ACTIVITY OUTSIDE JURISDICTION

Per California Penal Code Section 530.6, a victim of Identity Theft may request a police report with the law enforcement agency that has jurisdiction
over his/her actual residency or place of business. The law enforcement agency is required to take the report. If the suspected crime was committed in
a different jurisdiction (i.e. suspect using victim’s info to cash checks in other cities), the local law enforcement agency does not have to investigate
the case and may refer the matter to the law enforcement agency where the suspected crime was committed for further investigation.

The Oakland Police Department (OPD) will NOT conduct additional or follow-up investigations if the fraudulent activity occurred outside of the City of
Oakland. OPD will receive the report you completed involving suspect activity and may forward a copy of this report to the agency or agencies with
investigative jurisdiction where the identity theft or transaction(s) are believed to have occurred. An OPD investigator may contact you and direct you
where to send any additional information you receive associated with your case. You are advised to contact those agencies directly to inquire about
the status of your case. OPD will not have any information about investigations by other agencies.

Identity Theft and Fraud Victim Referral Information

Follow all the steps outlined below and contact the listed companies to reduce damage to your credit records and addi-
tional fraudulent activity and assist law enforcement with the investigation.

1. Keep a log or chronology of your case: Write and keep an open chronology of all identity theft and fraudulent activity or
events that occur with your identity theft or fraud case. Start from the date of the first known fraudulent transaction. List each sep-
arate transaction and activity by the following: Date, Day, Time, Account, Account Number, Names and Phone Numbers of people
you contacted about the fraud. Include a brief topic of all conversations and any work you did. Include as much detail as possible.
Example:
06-10-2006 Thu New credit account used at JCPenney store, Newark CA, #502 644 200 45. My name, address and SSN used. Charges
of $1,435.50 made to account. This information was learned from bill and JCPenney customer service on 07-02-04.
07-02-2006 Fri Received first JCPenney statement for Acct. # 502 644 200 45. Called JCPenney to report fraud, 800-555-1234. Spoke
to customer service rep “John” about fraud. Account was opened at the store on 06-02-2004. Account closed today.
2. Start a file folder. Keep all bills, statements, correspondence, and mail received for accounts you did not open or author-
ize, accounts opened in another name at your address, or accounts using your personal information.
3. You must call each of the following credit reporting bureaus. Only one call is needed to place a “fraud alert” with all three
bureaus. You are advised to call each credit bureau and report that you have been a victim of identity theft or fraud. Request a
copy of your credit report from each bureau. Request a victim statement be added to your credit file. Ask that your name be
removed and “opt-out” of pre-approved offers of credit. If fraud is major, ask about “Security Freeze” on credit files.

Experian (888) 397-3742 Opt-Out (888) 567-8688 Web site information: http://www.experian.com
Equifax (800) 525-6285 Opt-Out (888) 567-8688 Web site information: http://www.equifax.com
Trans Union (800) 680-7289 Opt-Out (888) 567-8688 Web site information: http://www.transunion.com

4. Read your credit reports carefully. Compare each account listed to your accounts and credit.
Contact all financial institutions, merchants, and stores where accounts have been fraudulently opened or created or your
accounts accessed without your knowledge. Cancel fraudulent and accessed accounts. Advise each creditor whose new account is
fraudulent (Send letters). Ask: a) when, b) where, and c) how the account(s) were opened. Get copies of all credit applications or
transaction records. Take notes. You are entitled to copies of all applications and account activity created by an identity theft.

5. Bank and Checking Accounts:

Carefully check your bank, checking, credit, and investment account statements and balances. Contact the bank and get a summa-
ry of all recent activity. Alert them you are a fraud victim. You may need to change your account numbers, automated banking
(ATM) card number, and Personal Identification Number (PIN). Record date, number called, and whom you spoke to.

6. If your accounts were accessed or if checks were stolen, used, or fraudulently created:
a) You may need to cancel your current accounts and transfer balances to new accounts with a new number. Place stop pay-
ments on outstanding checks that have not cleared. Contact the merchants directly where fraudulent checks were used and
report the fraud. Dispute charges and request fraudulent checks not go to collection in your name. Send Dispute Letters.
b) Call the major check verification companies. Ask merchants who they use for check verification. If your check(s) or check
account information has been used at a merchant, store, or online, contact the verification company used by that merchant.

Check Rite (Global) (800) 234-7800 Check Systems (800) 428-9623 Cross Check (800) 843-0760
National Processing (800) 234-7800 Tele Check (800) 710-9898 SCAN (800) 262-7771

7. Social Security Number fraud: Fraud Hotline: (800) 269-0271 http://www.ssa.gov/pubs/idtheft.htm

8. Mail fraud & Change of Address: Postal Inspectors (800) 275-8777 http://www.usps.com/postalinspectors/

9. Additional resources: a) http://www.privacyprotection.ca.gov/ b) http://www.ftc.gov/idtheft.htm