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Hazlet Township Police Department

Fraud / Identity Theft Report

Definition: Obtaining another person's personal identifying Information and using it to fraudulently obtain credit, goods or services.

Example: Someone uses your S.S.N. and other identifying information to fraudulently open a credit card account or opens a new cell phone plan without your permission.

In order to make report of fraud, the incident MUST have occurred in Hazlet Township or you must be a resident of Hazlet Township.

Driver License Number

Driver License State

Phone Number

Date when Incident Occurred:

Between: *

And: *

Time frame of when Incident Occurred:

Between:

And:

What are you reporting?

Fraud

Identity Theft

Monetary loss (Money Value)

What personal information has been compromised?

Personal identify information (SSN, DOB, name/ address)

Bank Account / Credit Card Information

Other

Name and Contact for Financial Institution

If other, Please explain

Narrative

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I certify this report to be truthful with all accurate information to the best of my knowledge.

First Name

Last Name

Choose how to sign

Draw Type

By checking this box, I understand filing a false police report is a crime. Any person who gives or causes to be given false information to any law enforcement officer, with respect to the commission of any crime or incident, is guilty of a fourth degree crime under the New Jersey Code of Criminal Justice (2C:28-4). Fourth degree crimes are punishable by a fine of not more than $ 1,000.00, or by imprisonment for not more than 18 months, or both.

Receipt

You will be provided with a Receipt upon submission.