To IC-3:
https://complaint.ic3.gov/default.aspxComplaint Referral Form
Internet Crime Complaint Center
Please review your complaint for accuracy, prior to submitting it to the IC3.
The following information was provided by the victim and may be forwarded to the
appropriate law enforcement or regulatory agencies.
Your Personal Information * First Name:Paulette
Middle Name:Anne
* Last Name:
Business Name:
Paulette Anne* Age:40 - 49
* Gender:F
* Address:40*********
Address (continued):
Suite/Apt./Mail Stop:
* City:*********
Do you live within the city limits?: Yes No
County:
State:Arizona
* Country:United States
* Zip Code / Route:****
* Phone Number:******
* E-mail Address:ugha323*****
Name of your local police or sheriff's office:
P********* P.D.
Is the complaint you are filing related to the Internet or an online service?
Yes No
Do you have pertinent documents in paper form?
Yes No
* Please specify the total dollar amount of your loss from this incident:
$ 125 Loss (US Dollars)
Additional Information
I have an entertainment business and this person has HIJACKED my name and using it for slander purposes:
This is MY youtube acct to show you:
http://www.youtube.com/user/ugha323a?feature=mhee GayJTFuckerPeriod, VictorVancier, HankTheSkankCryBaby, AintiChaimBenPesach, aBillionRosenbergs, Mr4international, belleaguered1956, EastEurope87, ChaimHimself On these Youtube accounts:
PLEASE HELP Thank you
Please indicate any medium used by the individual/business in the course of the incident.
Bulletin board
Chat room
Email
Fax
In person
Internet messaging
Mail
Newsgroup
Telephone
Web siteWire
Other
Please indicate the initial means of contact with the individual/business that victimized you.
Other
Was this initial means of contact unsolicited/uninvited?
Yes No
What was your relationship with the individual/business you are complaining about prior to the incident you are reporting?
online acquaintance
Did you conduct any research on the individual/business prior to the incident?
Yes
NoHow much time has passed since you determined you were victimized?
Less than 1 weekContact Information
Are there witnesses or other victims to this crime?
[
Yes]Have you reported this crime to any law enforcement or government agencies?
Better Business Bureau
Consumer protection agency
Individual/business that victimized you
Police/other law enforcement
Private attorneyDigital Signature
Read the following statement below, and confirm your agreement by typing your full name below in the box provided:
By digitally signing this document, I affirm that the information I provided is true and accurate to the best of my knowledge. I have read the IC3's Privacy Policy, and understand that this information will be maintained and controlled by the FBI and shared with the National White Collar Crime Center as a partner in the IC3, and additionally may be shared with law enforcement and regulatory agencies. If available, I will provide additional documentation not included in this complaint, such as email correspondence, payment receipts, or electronic logs, upon request to the best of my ability. I authorize the dissemination of the complaint, or information in the complaint, to appropriate federal, state, local, tribal, or international Law Enforcement Agencies (LEAs) for purposes of investigating the complaint.