Crime Victim Complain Form: Identity Theft
Centerville Police Department
101 Centerville Street
Centerville, Kansas, 05699
Tel [HIDDEN]
Date Complaint Filed: July 5, 2011
Victim Information:
Crime Victim Complaint Form: Identity Theft
Sally Gertrude Frederick
123 12th Avenue, Centerville, KS 05699
Tel [HIDDEN]
DOB: 01/24/1962
SSN: 466-55-1254
Drivers Lic.: Kansas, 18955243
Length of Residence at Current Address: 3 days
Victim's Previous Home Addresses for Past 5 Years:
435 14th Street, Apt. 233, Centerville, KS 05699
How long at this address: 7-1/2 years
Victim Information at Time of Fraud:
435 14th Street, Apt. 233, Centerville, KS 05699
Tel [HIDDEN]
SSN: 466-55-1254
Drivers Lic.: Kansas, 18955243
Email:
Declaration:
The victim declares that she has never authorized anyone to use her personal information to obtain money, credit, loans, goods, services, or for any other purpose, nor has she received any of the same as a result of the events described here. Ms. Frederick also agrees to provide any assistance the police may require to investigate and prosecute any individual(s) suspected of committing this crime.
Victim Statement:
Ms. Frederick discovered...
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