Fill Out the Victim Affidavit Online

How this works: Fill in the boxes below with your own truthful, first-hand information. When you click Create My Affidavit, a completed PDF downloads to your device. Do not sign it yet — you'll sign on camera when you notarize it (a link is at the bottom).

Section 1 — Your Information

Full legal name

Date of birth

Phone

Street address City / State / ZIP Email Best way to reach you

Section 2 — The Purchase

Date you first contacted the seller

How you found or contacted the seller (check all that apply):

Name or profile the seller used Phone number(s) the seller used Breed / description of the dog

Price you were quoted ($)

Amount you actually paid ($)

How you paid (check all that apply):

Date of the exchange / pickup Location of the exchange Who you met (name or description)

Section 3 — How You Were Scammed

Check all that apply:

Section 4 — Your Financial Loss

Purchase price paid ($)

Veterinary / medical bills ($)

Other related costs ($)

TOTAL amount lost ($)

Section 5 — Evidence You Have

Check all that apply:

Keep your originals. You can attach copies when you upload or email your affidavit.

Section 6 — What Happened, In Your Own Words

Section 7 — Follow-Up

Are you willing to be contacted by the State Attorney's Office? Are you willing to testify in court if needed?

Section 8 — The Person You Met In Person (if any)

Did you meet a person face-to-face? Where you met them Name given / who you believe it was

Approximate age

Height / build

Hair, beard, tattoos, or other features Vehicle (make, model, color, plate) Anything else that could help identify this person

Declaration

Under penalties of perjury, you declare the statement is true and correct to the best of your knowledge. Enter your name; you will sign in front of the notary.

Printed name Date

Your affidavit PDF has downloaded.

Next: notarize it online (do not sign until you're on the video call), then upload or email it.

🔒 Notarize Online 📤 Upload Securely

Please also email it to rduckworth@coj.net (cc drterriabsher@gmail.com), subject: Puppy Fraud Victim Affidavit — Case 26AF023721AD — [Your Last Name].

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