[County of Chester] Identity Theft

Identity Theft Form

Agency

Officer Name

Phone Number

Do you want to be notified when entry is complete?

Yes

Type of Identity Theft

Password chosen by victim. Must be 1-8 alpha numeric characters.

Municipality

IH#

Incident Date

Report Date

Subject Name

First

Middle

Last

Suffix

Gender

Race

Place of Birth (State)

Date of Birth

Height

Weight

Eye Color

Hair Color

SSN #

FBI #

SID #

Describe any scars, marks or tattoos

Comments/ Info ref finger/footprints etc.

Attach Photo(s) if available

Click Here to Upload

Recaptcha Response

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