NAME OF THE COURT

PLAINTIFF'S NAME
Plaintiff

vs
Court Case: 1234565rfke
DEFENDANT'S NAME
Defendant

AGGRAVATED IDENTITY THEFT WARNING

Dear Recepient's name (proper style),

This notice is a warning to you and all officials and agents alike to CEASE AND DESIST from
all use and attempts to use any means of identification of JOHN DOE and any derivative thereof
to obtain financial or person gain or benefits from the Social Security Title I-VD Program, wage
garnishments or any other purpose without the expressed written consent of Your Name (proper
style). Such aggravated identity theft is a federal crime pursuant to 18 U.S. Code § 1028A(a)(1)
which states:

"Whoever, during and in relation to any felony violation enumerated in subsection (c),
knowingly transfers, possesses, or uses, without lawful authority, a means of identification of
another person shall, in addition to the punishment provided for such felony, be sentenced to a
term of imprisonment of 2 years."

The term “means of identification” means any name or number that may be used, alone or in
conjunction with any other information, to identify a specific individual, including any— (A)
name, social security number, date of birth, official State or government issued driver’s license
or identification number, alien registration number, government passport number, employer or
taxpayer identification number; (B) unique biometric data, such as fingerprint, voice print, retina
or iris image, or other unique physical representation; (C) unique electronic identification
number, address, or routing code; or (D) telecommunication identifying information or access
device (as defined in section 1029(e).
Your Name (proper style) clearly states that he does not consent to any contractual
agreements whatsoever with respect to child support obligations. Therefore any future attempts
to use means of identification of Your Name (proper style) shall constitute fraud of aggravated
identity theft perpetrated by all individuals, officials and agents involved.
Upon notification of receipt of this warning please be advised that this warning shall be filed in
the above-mentioned case for the public record. NOTICE TO AGENT IS NOTICE TO
PRINCIPAL, NOTICE TO PRINCIPAL IS NOTICE TO AGENT. Furthers says not.
Thank you for your cooperation,

Respectfully,

Your Name (proper style) By: ____________________________

℅ Street address
Your Name (proper style) Nameholder,
City, State, [zip]
Authorized Representative for JOHN
DOE a People of Your State Republic

Certificate of Service
This is to certify that a copy of this “Aggravated Identity Theft Warning” with a COL Form
Violation Warning has been served to the following individual(s) at their provided mailing
addresses by way of regular, certified mail or via process server:

Recepient's name (proper style)

Street address
City, State, zip
Certified mail: 123456789

Recepient's name (proper style)

Street address
City, State, zip
Certified mail: 123456789

Recepient's name (proper style)

Street address
City, State, zip
Certified mail: 123456789

Subscribed and sworn (or affirmed) before me this ____ day of November, 2019

________________________________
Notary Public