ID Theft Affidavit

Victim Information My full legal name is Dorian Mayhew Rothschild. My date of birth is May 14, 1986. My social security number is .

My driver's license or identification card state and number is D9942542. My current address is 60 Arthur St., San Rafael, CA 94901. I have lived at this address since 2 years. My daytime telephone number is (415) 745-1554. My evening telephone number is (415) 885-1567. Victim's Law Enforcement Actions I am willing to assist in the prosecution of the person(s) who committed this fraud. I am authorizing the release of this information to law enforcement for the purpose of assisting them in the investigation and prosecution of the person(s) who committed this fraud. I have not reported the events described in this affidavit to the police or other law enforcement agency. Signature I declare under penalty of perjury that the information I have provided in this affidavit is true and correct to the best of my knowledge.

________________________________ Dorian Mayhew Rothschild

____________________________ (Date signed)

Knowingly submitting false information on this form could subject you to criminal prosecution for perjury.

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STATE OF CALIFORNIA COUNTY OF _________________________ On __________________ before me, ___________________________________, personally appeared Dorian Mayhew Rothschild, who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal.

________________________________________ (Notary Seal) Signature of Notary Public

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Fraudulent Account Statement

As a result of the event(s) described in the ID Theft Affidavit, the following account(s) was/were opened at your company in my name without my knowledge, permission or authorization using my personal information or identifying documents: Creditor Name: Creditor Address: Account Number: Type of Account: Date Issued/Opened: Amount/Value: Redwood National Credit Lenders 440 Montgomery St. San Francisco, CA 94103 1553467 Credit April 27, 2012 $550.00

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