Fillable INSTRUC TIONS do not receive the completed Identity (Central Hudson)

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INSTRUC TIONS do not receive the completed Identity (Central Hudson)

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  • 12 check-boxes
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INSTRUC
TIONS
R
ec
en
tly
,
you reported
that
your name
and/or
personal
information
were fraudulently used
to obtain
electric
and/or natural
gas service
from
Central Hudson. Central Hudson
will
suspend collection activities
on the
disputed
amount for
30 days
from the
date you originally contacted
our
offic
e
.
If
we
do not
receive
the
completed Identity
T
hef
t
Affidavit
with the
required
supporting
documentation
within
30 days, we
will
close your claim and resume collection
ac
tivities
.
In
order for Central Hudson
to
investigate your claim
that
this billing is
fraudulent, you
must:
*
File a police
report with
your claim
of fr
aud
.
*
Complete
the
attached Identity
T
hef
t
A
ffida
vit
,
notarize
it
and
return it with
a copy
of
your police
r
epor
t
,
copies
of 2 forms
of identification
and
proof of
r
esidency
.
• Driver’s
License
•
S
ocial
S
ecur
it
y
C
ar
d
• P
asspor
t
• DSS
Benefit
C
ar
d
VALID FORMS OF IDENTIFICA
TION
(2 copied forms
r
equir
ed)
• Military
ID
•
S
tuden
t
ID
• Green
C
ar
d
• Birth
C
er
tifica
t
e
PROOF OF
RESIDENC
Y
For the disputed address showing where you actually resided during the disputed time frame.
(1 copy
r
equir
ed)
•
R
ental/lease
agreement
•
Utility or
telephone
bill
•
Deed
• Bill
of
sale
• Mortgage
statement
• Tax
retur
ns
,
W2 forms
or
pay
stubs
• Notarized landlord
statement
(requires signature of
landlor
d)
• Incarceration papers
with the
date
incar
c
er
a
t
ed
and
the
date
of release
Return this completed and notarized Identity Theft Affidavit packet with
a
copy of your police report and copies of 2 forms
of
identification and proof of
residency within 30 days
by:
MAIL:
FAX:
EMAIL
:
Central Hudson
Gas
and Electric
C
or
p
.
(845)
486-5658
ID
T
hef
t@c
enhud
.c
om
Attn:
ID
T
hef
t
Claim
284
S
outh Avenue
P
oughkeepsie
,
NY
12601
Central Hudson
will notify
you
in writing within
30 days
of
receiving this completed and notarized Identity
T
hef
t
A
ffida
vit
,
police
r
epor
t
,
2
forms
of identification
and
proof of
residency
of the
results
of
this claim.
If
you have any additional
questions
,
please
give
us a call
at
(845)
452-2700.
For
additional information on how
to
report and
recover from identity theft, visit the Federal Trade Commission website:
Identit
y
T
hef
t.go
v
APPLICATION
(1)
My
full
legal
name:
First
Middle Last
(2)
C
urr
en
t
addr
ess:
(3)
T
elephone
number
:
(4)
S
ocial
secur
it
y
number
:
(5)
Dr
iv
er’
s
lic
ense
number
:
Ho
w long
ha
v
e
y
ou
liv
ed
a
t
y
our
cur
r
en
t
addr
ess?
Dr
iv
er’
s
lic
ense
sta
t
e:
(6) Have you ever lived
at the
disputed residence?
Yes
No If
yes,
what
were
the
da
t
es?
(7)
Where were you
living during the
disputed
billing period?
S
tr
eet
City
S
ta
t
e
Zip
(8) Did you authorize anyone
to
use your name
or
personal
information to
open a Central Hudson
acc
oun
t
in
your
name?
Yes
No
(9) Do you
know
anyone
who
may have used your name
or
social security
number?
Yes
No
If
yes,
what
is
that
person’s
name?
A
ddr
ess
(if
k
no
wn):
S
tr
eet
City
S
ta
t
e
Zip
P
hone#
Are
they
a
friend or
relative?
If
yes, please
e
xplain:
A
r
e
you
willing to
assist
in the
prosecution
of the
person(s)
who committed
this
fraud?
Yes
No
Do you authorize
the
release
of
this
information to
law enforcements
for the
purpose
of
assisting
them in the
investigation
and
prosecution
of the
person(s)
who committed
this
fraud?
Yes
No
(10) Did you
report the
events described
in
this affidavit
to the
police
or other
law enforcement agency?
Yes
No
I
f
yes, please
provide a
c
op
y
with
this Identity
T
hef
t
Affidavit and the other required documents in order that we may review your
claim.
I
f
no
,
then
y
ou
m
ust
file
a
r
ep
or
t
and
submit
a
c
op
y
along
with
this
Identit
y
T
hef
t
A
ffidavit
and
the
other
r
equir
ed
do
cuments
b
efor
e
w
e
r
eview
y
our
claim.
A
dditional
c
omments/e
xplanations:
It
is your respons bility
to file
charges
with the
appropriate law enforcement agency and
to
c
ooper
a
t
e
in the
prosecution
of
fraud
committed
against y
ou
.
We
will
require
proof that
you have made such a
filing
,
or if the
law enforcement
agency fails
or
refuses
to
accept your
attempt to file
char
ges
,
a
written
statement
of
reason is
requir
ed
.
If
you
do not
comply
with
this pr
oc
edur
e
,
Central Hudson
Gas
and Electric Corporation
will not
take action
to
remove this
acc
oun
t
from
your name and
will
continue
to hold
you responsible
for the debt
.
P
r
in
t
name Signature
S
w
orn
to
and subscribed before
me
This
day
of 20
Notary signature
stamp
In
order for Central Hudson
to
investigate your claim
that
this billing is
fraudulent, you
must:
*
File a police
report with
your claim
of fr
aud
.
*
Complete
the
Identity
T
hef
t
A
ffida
vit
,
notarize
it
and
return it with
a copy
of
your police
repor
t
,
copies
of 2
forms
of identification
and
proof of
r
esidenc
y
.
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INSTRUC TIONS do not receive the completed Identity (Central Hudson)

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Completed 9 June 2021

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