i.d. page 2

Your e-mail address:                                    Your full Name:

Your Address (include city & state):             Your Date of Birth:

Your Social Security Number:                       Your Home Phone Number:

Driver's License number and state:

THE REPORT SHOULD INCLUDE:

How you became aware of stolen I.D.

Company Names and Account Information were I.D. was used.

Have you spoken with Companies effected?

Suspects if any.

Any other information you have gained about the incident.

Cost / how much was charged? 

--------------------------------Example Writing------------------------------------

  E-mail: jhay@yahoo.com

  First Name: John

  Last Name: Smith

  Address: 123 Main St Waltham MA

  Date of Birth: 01/01/1956

  Social Security Number: 000-00-0001

  Home Phone Number: (123) 456-6789

  Driver's License: MA-S1234567

I recieved a notice in the mail for an outstanding balance due on Mastercard account #12345678, I do not have a mastercard account. I have spoken with mastercard and they informed me that there was an account in my name and provided me with my information, i informed them that I did not open the account and they assured me thay would investigate the mattter but wanted me to file a police report.

After completing your report send it to ddallacosta@city.waltham.ma.us