Section 61.35.8. Identity theft passport application and verification forms.

       35.8(1) Identity theft victim application and affidavit. The following form may be used to apply for an identity theft passport.

Iowa Attorney General's Office

Identity Theft Victim Application and Affidavit

Iowa Code section 715A.9A(2): A victim who has filed a report of identity theft with a law enforcement agency may apply for an identity theft passport through the law enforcement agency. The law enforcement agency shall send a copy of the police report and the application to the attorney general, who shall process the application and supporting report and may issue the victim an identity theft passport in the form of a card or certificate.

Section I: Victim Information
a. Full given name:  ______________________________
b. Common use name:  ___________________________
c. Aliases:  _____________________________________
d. Birth date:  _______________________________________	e. Social Security Number:  ________________________
f. Driver's License Number:  _______________________
g. Street address:  _______________________________
h. City:  _______________________________________	State:  ________________________________________	Zip Code:  _____________________________________
i. Your home telephone number:  ___________________

Section II: Crime Information
a. Date(s) of identity theft:  ________________________
b. Item(s) stolen:  _______________________________
c. Location of crime:  ____________________________________________	d. Date(s) reported:  ____________________________________________
e. Law Enforcement Agency:  ______________________
f. Name of suspect, if known:  _____________________
g. Relationship of suspect to victim:  _________________
h. Other information (use additional page(s) if necessary):
_______________________________________________

Section III: Other Information to Be Supplied Before a Passport May Be Issued

a. A copy of the victim's current driver's license or state-issued nonoperator's identification card; or, if neither is available,

b. A current photograph of the victim certified as valid by signature of the law enforcement investigator who received the report of identity theft.

By signing this affidavit, I attest that the information provided above is true and accurate. I acknowledge that I did file an accurate and true law enforcement report of this incident(s).

_______________________________________________		_______________________________________________
Signature		Date

       35.8(2) Identity theft law enforcement report verification. The following form must be completed by the investigating officer and submitted in conjunction with the identity theft application and affidavit.

Iowa Attorney General's Office

Identity Theft Law Enforcement Report Verification

Iowa Code section 715A.9A(5): An application made with the attorney general under subsection 2, including any supporting documentation, shall be confidential and shall not be a public record subject to disclosure under chapter 22.

Section I: Law Enforcement Agency

a. Name of Law Enforcement Agency:  ______________

b. Law Enforcement Agency telephone number:  _______

c. Name of Investigating Officer completing this report:  _

 

Section II: Information Requested from Law Enforcement Agency
a. Did the victim named in the attached Identity Theft Application and Affidavit report to your law enforcement agency the crime of identity theft? <fo:wrapper font-size="20pt">□</fo:wrapper>Yes <fo:wrapper font-size="20pt">□</fo:wrapper>No
b. Date of report:  ____________________________________________	c. LE case number:  _____________________________________________
d. Has a suspect been identified? <fo:wrapper font-size="20pt">□</fo:wrapper>Yes <fo:wrapper font-size="20pt">□</fo:wrapper>No
e. If yes, name of suspect:  ________________________
f. Have charges been filed?  _______________________
g. Is issuance of an Identity Theft Passport warranted in this case? <fo:wrapper font-size="20pt">□</fo:wrapper>Yes <fo:wrapper font-size="20pt">□</fo:wrapper>No
h. Other information (use additional paper if necessary):  _
_______________________________________________

_______________________________________________		_______________________________________________
Signature of Investigating Officer		Date

       35.8(3) Submission of documentation. In order to be considered for an identity theft passport, a victim must submit the following documentation to the Crime Victim Assistance Division, Ground Floor, Lucas State Office Building, Des Moines, Iowa 50319:

        a.           The Identity Theft Victim Application and Affidavit form, signed by the victim.

        b.           The Identity Theft Law Enforcement Report Verification form, signed by the investigating officer.

        c.           A copy of the law enforcement agency's investigative report.

[ARC 7940B, IAB 7/15/09, effective 8/19/09]