Express VP N [ Bookingcom @ Cat 5., Accounts Affected by the Crime ' Fraudulent Personal or Business Loan Company or Organization: Achieve loans Date that | discovered It Total fraudulent amount 8/2023 : - B 0 Under penalty of perjury, | deciare this information Is true and correct to the best of my knowledge. | understand that knowing ly making any false statements to the government may violate federal, sta imprisonment, or both. te, or local criminal statutes, and may result in a fine, THOMAS michael KIELBASINSKI ikl e AR THOMAS michael KIELBASINSKI Date Use this form to prove to businesses and credit bureaus that you have submitted a might request that you also file a report with your local police. n FTC ldenfityTheft Report to law enforcement. Some businesses
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