Department of the Treasury - Internal Revenue Service                                       OMB Number 
Form 14039                                                                                                                                     1545-2139
     (May 2024)                                        Identity Theft Affidavit
This affidavit is for victims of identity theft. To avoid delays do not use this form if you have already filed a Form 14039 for this incident.
Form 14039 can also be completed online at https://www.irs.gov/dmaf/form/14039.
The IRS process for assisting victims selecting Section B ,Box 1 below is explained at irs.gov/victimassistance.
Get an IP PIN: We encourage everyone to opt-in to the Identity Protection Personal Identification Number (IP PIN) program. If you don’t have an IP PIN, you 
can get one by going to irs.gov/ippin. If unable to do so online, you may schedule an appointment at your closest Taxpayer Assistance Center by calling 
(844-545-5640). Or, if eligible, you may use IRS Form 15227 to apply for an IP PIN by mail or FAX, also available by going to irs.gov/ippin.
Section A - Check the following boxes in this section that apply to the specific situation you are reporting (required for all filers) 
    1.  I am submitting this Form 14039 for myself
    2.  I am submitting this Form 14039 in response to an IRS Notice or Letter received
     •  Provide ‘Notice’ or ‘Letter’ number(s) on the line to the right
     •  Check box 1 in Section B and see special mailing and faxing instructions on reverse side of this form.
    3.  I am submitting this Form 14039 on behalf of my dependent child or dependent relative (include that person’s information below in Section C and D)
     •  Complete Sections A-F of this form. Do not use this form If dependent’s identity was misused by a parent or guardian in filing taxes, this is not 
        identity theft.
    4.  I am submitting this Form 14039 on behalf of another person living or deceased (other than my dependent child or dependent relative)
     •  Complete Sections A- F of this form.
Section B – How I Am Impacted (required when reporting misuse of Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN))
Check all boxes that apply to the person listed in Section C below. If the person in Section C has previously submitted a Form 14039 for the same incident, 
there’s no need to submit another Form 14039.
    1.  I know or suspect that someone used my information to fraudulently file a federal tax return
        I/My dependent was fraudulently/incorrectly claimed as a dependent (use that person’s information for Section C & D) 
        My SSN or ITIN was fraudulently used for employment purposes
Note: If you are a victim of Identity theft but it does not involve your federal tax return, you should request an IP PIN to protect yourself. Get An Identity 
Protection PIN | Internal Revenue Service (irs.gov)
Provide an explanation of the identity theft issue, how it impacts your tax account, when you became aware of it and provide relevant dates. If needed, 
attach additional information and/or pages to this form

Section C – Name and Contact Information of Identity Theft Victim (required)
Victim’s last name                              First name                                Middle         Taxpayer Identification Number  
                                                                                          initial        (provide 9-digit SSN or ITIN)

Current mailing address (apartment or suite number and street, or P.O. Box)  Current city                       State               ZIP code
If deceased, provide last known address
                                                                                                                                               -
Address used on last filed tax return (if different than ‘Current’)         City (on last tax return filed)     State               ZIP code
                                                                                                                                               -
Telephone number with area code. The IRS may call you regarding this affidavit                                  Best time(s) to call
Home phone number                                       Cell phone number
Language in which you would like to be contacted                    English            Spanish           Other
Section D – Tax Account Information: Last tax return filed (year shown on the tax return) and Returns Impacted
I was not required to file a return or filed a return with no income information
Names used on last filed tax return                                         The last tax return filed (year shown on the tax return)

What Tax Year(s) you believe were impacted by tax-related identity theft (example: 2020 is input for citing the 2020 tax return though filed the next 
year(s). (if not known, enter ‘Unknown’ below))

Submit this completed form to either the mailing address or the FAX number provided on the reverse side of this form.
Catalog Number 52525A                                                  www.irs.gov                                            Form 14039 (Rev. 5-2024)

Section E – Penalty of Perjury Statement and Signature (required)
Under penalty of perjury, I declare that, to the best of my knowledge and belief, the information entered on this Form 14039 is true, correct, complete, and 
made in good faith.
Signature of taxpayer, or representative, conservator, parent or guardian                                                                            Date signed

Section F – Representative, Conservator, Parent or Guardian Information (required if completing Form 14039 on someone else’s behalf)
Check only ONE of the following five boxes next to the reason you are submitting this form
   1.  The taxpayer is deceased, and I am the surviving spouse
         •  No attachments are required, including death certificate.
   2.  The taxpayer is deceased, and I am the court-appointed or certified personal representative
         •  Attach a copy of the court certificate showing your appointment.
   3.  The taxpayer is deceased, and a court-appointed or certified personal representative has not been appointed
         •  Attach copy of death certificate or formal notification from a government office informing next of kin of the decedent’s death. 
         •  Indicate your relationship to decedent:       Child          Parent/Legal Guardian            Other
   4.  The taxpayer is unable to complete this form and I am the appointed conservator, or I have been authorized to act on behalf of the 
         taxpayer per Form 2848, Power of Attorney and Declaration of Representative
         •  Attach a copy of documentation showing your appointment as conservator or Power of Attorney authorization.
         •  If you have an IRS issued Centralized Authorization File (CAF) number, enter the nine-digit number:

   5.  The person listed above is my dependent child or my dependent relative
         By checking this box and signing below you are indicating that you are an authorized representative, as parent, guardian or legal guardian, to file a 
         legal document on the dependent’s behalf. 
         •  Indicate your relationship to person          Parent/Legal Guardian                      Power of Attorney
            Fiduciary per IRS Form 56, Notice of Fiduciary Relationship                              Other
Parent’s/Representative's name
Last name                                                            First name                                                                      Middle initial
Parent’s/Representative’s current mailing address (city, town or post office, state, and ZIP code)

Parent’s/Representative’s telephone number

Instructions for Submitting this Form
Submit this completed and signed form to the IRS via Online,Mail or FAX to specialized IRS processing areas dedicated to assist you. 
In Section C of this form, be sure to include the Social Security Number in the ‘Taxpayer Identification Number’ field.
Help us avoid delays:
   •  Do not use this form if you have already filed a Form 14039 for this incident.
   •  Choose one method of submitting this form either Online (preferred method), by Mail, or by FAX, not all methods.
   •  Provide clear and readable photocopies/images of any additional information you may choose to provide.
   •  Submit the original tax return to the IRS location where you normally file your tax return. Do not use the following address or fax number to file an 
   original tax return.
                       Online (Preferred Method)                                                          Submitting by Mail
•  https://apps.irs.gov/app/digital-mailroom/dmaf/f14039/                       •  If you checked Box 2 in Section A in response to a notice or letter 
                                                                                    received from the IRS, return this form and if possible, a copy of the 
                          Submitting by FAX                                         notice or letter to the address contained in the notice or letter.
•  Always include a cover sheet marked "Confidential”.                          •  If you checked Box 1 or 2 in Section B of Form 14039 and are unable 
•  If you checked Box 2 in Section A of Form 14039 and are submitting               to file your tax return electronically because the SSN/ITIN of you, 
   this form in response to a notice or letter received from the IRS. If it         your spouse, or dependent was misused, attach this Form 14039 to 
   provides a FAX number, you should send there.                                    the back of your paper tax return and submit to the IRS location where 
•  If no FAX number is shown on the notice or letter, follow the mailing            you normally file your tax return.
   instructions on the notice or letter.                                        •  All others should mail this form to: 
•  For all others, FAX this form toll-free to:                                                            Department of the Treasury 
                          855-807-5720                                                                    Internal Revenue Service 
                                                                                                          Fresno, CA 93888-0025
                                                     Privacy Act and Paperwork Reduction Notice
Our legal authority to request the information is 26 U.S.C. 6001. The primary purpose of the form is to provide a method of reporting identity theft issues to the IRS so that the IRS may document 
situations where individuals are or may be victims of identity theft. Additional purposes include the use in the determination of proper tax liability and to relieve taxpayer burden. The information may 
be disclosed only as provided by 26 U.S.C. 6103. Providing the information on this form is voluntary. However, if you do not provide the information it may be more difficult to assist you in resolving 
your identity theft issue. If you are a potential victim of identity theft and do not provide the required substantiation information, we may not be able to place a marker on your account to assist with 
future protection. If you are a victim of identity theft and do not provide the required information, it may be difficult for IRS to determine your correct tax liability. If you intentionally provide false 
information, you may be subject to criminal penalties. You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a 
valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. 
Generally, tax returns and return information are confidential, as required by section 6103. Public reporting burden for this collection of information is estimated to average 15 minutes per response, 
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have 
comments concerning the accuracy of these time estimates or suggestions for making this form simpler, we would be happy to hear from you. You can write to the Internal Revenue Service, Tax 
Products Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, IR-6526, Washington, DC 20224. Do not send this form to this address. Instead, see the form for filing 
instructions. Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with, a collection of information 
subject to the requirements of the Paperwork Reduction Act, unless that collection of information displays a currently valid OMB Control Number.
Catalog Number 52525A                                                    www.irs.gov                                                            Form 14039 (Rev. 5-2024)