F:\finaid\Finaid.docs\2017-2018 Docs\Victims of Identity Theft Worksheet1819.pdf NOV 3, 2017
University of Central Missouri
Office of Student Financial Services
PO Box 800
Ward Edwards 1100
Warrensburg, MO 64093-5178
Phone 660-543-8266 | FAX 660-543-8080
On-line: www.ucmo.edu/contactsfs
Victims of Identity Theft Worksheet
____________________________________________________ 700_____________________
Student’s Name (please print) UCM ID Number
The student, spouse or parent who is a member of the student’s household has indicated to our
office that (s)he is a victim of IRS tax-related identity theft. This information must be verified.
Therefore, please submit the following to the UCM Office of Student Financial Services at the
address or fax number at the bottom of this page.
1) A copy of the identity theft victim’s 2016 alternate paper tax return transcript known as the
Tax Return DataBase View (TRDBV).
This is obtained from the IRS by contacting the Identity Protection Specialized Unit of the IRS
at 1-800-908-4490. After the IRS authenticates the tax filer’s identity, (s)he can request the
IRS to mail the TRDBV to the tax filer. Once received, a copy can be forwarded to our office.
2) The victim, or victims, in the case of a joint return, must confirm the statement below is
correct by reviewing, signing, dating and submitting this form to our office.
I/We, ________________________________________________________________________,
Name(s) of identity theft victim(s) (please print)
was a victim/were victims of IRS tax-related identity theft for the 2016 tax year. The IRS
has been made aware of this tax-related identity theft.
______________________________________________________ ____________________
Signature of tax-related identity theft victim (tax filer) Date
______________________________________________________ ____________________
Signature of victim’s spouse who is a joint filer on their tax return Date
Complete and submit this form (and the required documents) to the UCM Office of Student Financial Services in
person, by mail (1100 Ward Edwards Bldg., Warrensburg, MO 64093-5178) or by fax (660-543-8080).
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