Name of the Victim Mailing Address Victim's Address Street Address Address Line 2 City Please SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington DCWest VirginiaWisconsinWyoming State ZIP Code Contact Details Victim's Phone Victim's E-Mail What was Forged? What was Forged? Check (personal or business)Cash Withdrawal VoucherLoan (note)Other Describe the forgery that took place. Describe the Forged Instrument: (only) Describe the Forgery: (in detail) Police Report Has a Police Report been filed? Has a Police Report been filed? YesNo When was the Police Report filed? Why hasn't a Police Report been filed? Why hasn't a Police Report been filed? I will be doing soonI didn't think it was necessaryOther Enter why a Police Report has not been filed: Notary Do you want to Notarize this Affidavit? Do you want to Notarize this Affidavit? Yes (recommended)No Date Date of this Affidavit Usually today's date. Next Save Save and finish later
