Compromised Identity
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Florida Department of Law Enforcement
Compromised Identity Review Claim Form
Disclaimer: This form is used for criminal record information only.
Your Full Name
Last Name :
First Name :
Middle Name :
Other Names Used
Last Name :
First Name :
Middle Name :
Last Name :
First Name :
Middle Name :
Current Mailing Address :
Address Line 1 :
Address Line 2 :
City :
State :
Select One
AS
GU
VI
BK
CZ
HO
JI
JR
KI
MK
PL
VL
WK
MH
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
DC
PR
CG
Zip :
Personal Information
Date of Birth :
Sex :
Select One
Female
Male
Unknown
Race :
Select One
American Indian or Alaskan Native
Asian
Black
Unknown
White
Social Security Number (Optional) :
Driver's License Number (Optional) :
Contact Information
Daytime Phone Number :
Alternate Phone Number :
Email Address :
Fax Number :
Preferred Communication :
Select One
Mail
Email
Fax
If you have previously completed a Compromised Identity case with FDLE, please provide your case number :
What event made you believe that your identity was used in an arrest record? :
Employment
Traffic Stop
Housing
Theft/loss
Others
Select
Please provide a brief explanation :
If known, include the following information regarding the identity of the person who was arrested using your personal information
Full Name
Last Name :
First Name :
Middle Name :
Other Names Used
Last Name :
First Name :
Middle Name :
Personal Information
Date of Birth :
Sex :
Select One
Female
Male
Unknown
Race :
Select One
American Indian or Alaskan Native
Asian
Black
Unknown
White
Social Security Number (optional) :
If known, please indicate which part of your identity was used :
Name
Date of birth
Social Security Number
Select
Was the possible offender a :
Relative
Stranger
Friend/Acquaintance
Unknown
Select
If you are aware of how your identity was obtained, briefly describe :
Along with this form, please provide any additional information or documentation (i.e. court or law enforcement documents) that may support your claim. In order to process your claim form, a copy of an identification card with a photo ID is required.
Please mail completed form, original fingerprint card, and a photo ID to:
Florida Department of Law Enforcement
P.O. Box 1489
Tallahassee, FL 32302
Attn: CHRM - Arrest Maintenance
Law Enforcement Officer or Agency Designee: Please verify identity information above against a photo ID.
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