Download IRS Form-14039: Identity Theft Affidavit

Form 14039 to report Identity Theft Revised December 2012

IRS Form-14039 is an affidavit form used to report in the situation of identity theft. After filling this affidavit form you need to submit this to Department of the Treasury – Internal Revenue Service if you are the actual or potential victim of identity theft. IRS will  mark your account for questionable activity.

You need to choose in between (or both) of the below situation with proper documentation.

  • I am submitting this form in response to a mailed notice or letter from the IRS.
  • I am completing this form on behalf of another person, such as a deceased spouse or other deceased relative. You should provide information for the actual or potential victim in Sections A, B, & D.

Download Form-14039 for Identity Theft Affidavit

Download Identity-Theft-Affidavit-Form.pdf (95KB)

Download and fill above Identity Theft Affidavit form.  After filling above form send this to the following address:

Internal Revenue Service
PO Box 9039
Andover MA 01810-0939

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