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BUREAUS FINANCIAL/PROPERTY CRIME
FORGERY DETAIL: WORTHLESS DOCUMENT REPORT

Bureaus > Financial/Property Crime > Forgery Detail > Worthless Document Report

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VOLUNTARY STATEMENT
WORTHLESS DOCUMENT REPORT

INSTRUCTIONS

  1. Enter location of where transaction occurred. If multiple locations, enter location where the most suspect information can be obtained ( video, print on check or document, etc.).
  2. Enter date transaction occurred or dates transactions occurred between.
  3. Enter the incident-event number reported by cardholder or account holder.
  4. Enter the information about the victim whether it is a business or an individual. If victim is a business put name of business contact on same line. Example: BigBank Visa / John Doe.
  5. Enter the information about the clerk or cashier who handled the transaction.
  6. Enter any information of the suspect if known. If not known enter information in the narrative which might lead to a suspect. Check the " Suspect Vehicle" Box if there is a suspect vehicle involved and enter any information on that vehicle.
  7. Same as Number 6 above, if there is a second suspect.
  8. TYPE OF DOCUMENT: Mark type of document used.
    • Credit Card/Bank Company: List Bank or Credit Card Company name.
    • Amount: Enter amount of loss.
    • Reported Lost/Stolen: Check yes or no if document was reported lost or stolen. Card or Account Number: Enter credit card number or account number.
    • Card Holder: Enter information about account or card holder and phone number.
    • Company Notified: Check if Company notified.
    • If Yes, Name, Address, Phone # of Individual: Name of contact (from Victim Company), mailing address and phone number.
    • Inked Print on Check: Check if there is an Inked Fingerprint on the check or document.
    • Photo or Video of Suspect: Check if there are Photos or Video of suspect.
  9. NARRATIVE: All details of transaction and any other pertinent information.

    Incident Information

    INCIDENT INFORMATION
    Specific Crime
    Location of Incident
    Street Address City
    Bldg/Apt# State
    Zip Code
     
    Month Day Year Day of the Week Time
    Occurred
    On/Between
     
    VICTIM INFORMATION
    Name Sex
    Date of Birth Height
    SSN Weight
    Race Hair
    Eyes
    Work Schedule
    Victim Address
    Street Address City
    Bldg/Apt# State
    Zip Code
    E-mail Address
    Residence Phone Business Phone
     
    WITNESS INFORMATION
    Name Sex
    Date of Birth Height
    SSN Weight
    Race Hair
    Eyes
    Work Schedule
    Witness Address
    Street Address City
    Bldg/Apt# State
    Zip Code
    E-mail Address
    Residence Phone Business Phone
     
    SUSPECT 1 INFORMATION
    Name Sex
    Date of Birth Height
    SSN Weight
    Race Hair
    Eyes State ID/DL#
    Work Schedule Occupation
    Suspect 1 Address
    Street Address City
    Bldg/Apt# State
    Zip Code
    Business/School
    Residence Phone Business Phone
    Suspect 1 Automobile Information
    Year Description
    Make License #
    Model State
    Color(s) Mo/Yr
     
    SUSPECT 2 INFORMATION
    Name Sex
    Date of Birth Height
    SSN Weight
    Race Hair
    Eyes State ID/DL#
    Work Schedule Occupation
    Suspect 2 Address
    Street Address City
    Bldg/Apt# State
    Zip Code
    Business/School
    Residence Phone Business Phone
    Suspect 2 Automobile Information
    Year Description
    Make License #
    Model State
    Color(s) Mo/Yr
     
    DOCUMENT INFORMATION
    Type of Document
    Credit Card/Bank Company
    Amount
    Reported Lost/Stolen
    Credit Card or Acct. No.
    Cardholder Information
    Name
    Address
    Phone Number
     
    Inked Print on Check Yes No
    Evidence Impounded Yes No
    Photo or Video of Suspect Yes No
    Company Notified Yes No
     
    If Yes, Name Address and Phone
    Narrative