HSMV 72068 (Rev. 09/22)
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTORIST SERVICES
DRIVER LICENSE/IDENTIFICATION CARD FRAUD INVESTIGATION REQUEST
Date of Complaint: _______________________ Office Number: ________________________
FLH
SMV/TC Representative’s Name: _________________________________________________
Compla
int originated from: Victim Law Enforcement Other
If
the complaint originated from Law Enforcement or Other, list the contact information to include
agency name, officer’s name, and contact information.
_____________________________________________________________________________
_____________________________________________________________________________
Has any formal complaint been made with any Law Enforcement or other government entity in
connection with this complaint? Yes No
If
yes, list the agency name, officer’s name, case number and contact information.
_____________________________________________________________________________
_____________________________________________________________________________
Wou
ld the victim like to have their record flagged? Yes No
Vic
tim/Complainant Information
Name:
First Middle Last
Address:
Address:
Current or Last Known Mailing Address to include County
Last Four (4) digits of FL DL/ID Number: __________ DL/ID Issue Date: _________________
Last Four (4) digits of OOS DL/ID Number: __________
Contact Number: ______________________________
Email Address: ________________________________
This form is to be completed ONLY when a victim is affected by driver license or
identification card fraud. If your complaint is in regard to a citation, you must contact
the court where the citation was issued to resolve the matter.
Types of DL/ID Fraud
Florida DL/ID Fraud Counterfeit Address Fraud Out of State
Certificate Fraud (
marriage, birth, social security, or passport)
Does the victim know the imposter? Yes No
Is the imposter related to the victim? Yes No
If yes, what is the relationship?
Possib
le Imposter’s Information
Name:
First Middle Last
Address:
Address:
Current or Last Known Mailing Address to include County
Last Four (4) digits of FL DL/ID Number: __________
Last Four (4) digits of OOS DL/ID Number: __________
Name:
First Middle Last
Address:
Address:
Current or Last Known Mailing Address to include County
Last Four (4) digits of FL DL/ID Number: __________
Last Four (4) digits of OOS DL/ID Number: __________
Complaint:(Please give as many details as possible)
Victim/Complainant’s Signature
Mail, Fax, or email the completed form and ALL supporting documents to:
Driver License Fraud Unit, 2900 Apalachee Parkway, MS 84, Tallahassee, FL 32399
Phone: 850-617-2405; FAX: 850-617-3945
Email:
fraud@flhsmv.gov
HSMV
72068 (Rev. 09/22)
HSMV 72068 (Rev. 09/22)
Division of Motorist Services
Bureau of Motorist Services Support
Driver License Fraud Unit
