Free Identity Theft Affidavit & Dispute Letter

[Your Full Name]
[Your Street Address]
[City, State ZIP]
[Date]

[Credit Bureau or Creditor Name]
[Address]

Re: Identity theft — request to block fraudulent information (FCRA § 605B)
[Your Name] — SSN ending in [XXXX]

To Whom It May Concern:

I am a victim of identity theft. The account(s) and information listed below were opened or used without my knowledge or authorization. I am requesting that you block this information from my credit report under the FCRA (15 U.S.C. § 1681c-2).

Fraudulent item(s):
  - Account/Creditor name: [Creditor Name]
  - Account number: [Account Number]

Enclosed are:
  - A copy of my FTC Identity Theft Report (from IdentityTheft.gov);
  - A copy of my government-issued ID and proof of address; and
  - [A copy of my police report, if one was filed].

Please block these items, notify the furnisher(s) as required by law, and send me written confirmation.

Sincerely,

[Your Signature]
[Your Printed Name]