Consumer Reporting Company Blocking Letter: Street Address City, State, Zip Code
Consumer Reporting Company Blocking Letter: Street Address City, State, Zip Code
RE: NAME
Street address
City, State, Zip Code
SSN: XXX-XX-XXXX
DOB: 1/1/2015
I am a victim of identity theft. I am writing to request that you block the following fraudulent
information from my credit report. I have no idea how the theft took place. I also have no knowledge of
any suspects. I did not receive any money, goods, or services as a result of the identity theft.
Account Name
Account Number
Date Opened
Balance
ABC COMPANY
12345XXXX
3/31/2015
$1,000
Judgement/ 1234567
2/28/2015
$2,500
XYZ COMPANY
6789XXXX
4/1/2015
$50
ABC Company
3/31/2015
XYZ Company
1/1/2015
This information does not relate to any transaction that I have made. I have enclosed a copy of my
Identity Theft Report. In addition, I have enclosed a copy of section 605B of the Fair Credit Reporting
Act, which details your responsibility to block fraudulent information on my credit report resulting from
identity theft. Please let me know if you need any other information from me to block this information
from my credit report.
Sincerely,
Name
IN WITNESS WHEREOF, the said party has signed and sealed these presents the day and year
first above written.
Signed, sealed and delivered in the presence of: {PRINT YOUR NAME HERE}
__________________________________ _________________________________
Witness 1 Print: Signature
__________________________________
Witness 2 Print:
STATE OF ______________
COUNTY OF ______________
I HEREBY CERTIFY that on this day before me, an officer duly qualified to take
acknowledgments, personally appeared NAME who is personally known to me or who has
produced _____________________________________________ as identification and who
executed the foregoing instrument and he/she acknowledged before me that he/she executed the
same.
WITNESS my hand and official seal in the County and State aforesaid this _____ day of,
____________________ 20 .
___________________________________
Notary Public
Printed Name:
My commission expires: