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Dear Sir or Madam: This letter confirms my conversation with , ID # . I am a victim of identity theft and my personal information has been improperly used in connection with tax violations. For identification purposes my social security number is and my date of birth is .
Providing the information on this form is voluntary. However, if you do not provide the information it may be more difficult to assist you in resolving your identity theft issue.
☐ Complete the FTCs online complaint form at ftc.gov/complaint. Give as many details as you can. The complaint form is not available on mobile devices, but you can call 1-877-438-4338 to make your report. ☐ Print and save your FTC Identity Theft Affidavit immediately.
To verify, youll need: A mobile phone that has a camera or a computer with a webcam. Email address. Government-issued photo ID (U.S. drivers license or state ID, U.S. passport, or U.S. passport card) Social Security number.
If you did not receive a notice but believe youve been the victim of identity theft, contact the IRS Identity Protection Specialized Unit at 800-908-4490, extension 245 right away so we can take steps to secure your tax account and match your SSN or ITIN. Also, fill out the IRS Identity Theft Affidavit, Form 14039.
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Submitting Form 14039-B BY MAIL: If you received a notice from the IRS, attach Form 14039-B to the back of the notice and mail to the address provided on the notice. If you did not receive a notice from the IRS, please send this completed form to Internal Revenue Service, Ogden, UT 84201.
You will need to fill out the IRS Identity Theft Affidavit, Form 14039.

form 14039 2022