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State of Alaska: Department of Revenue
Permanent Fund Dividend
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Report Fraud
State of Alaska
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Revenue
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Permanent Fund Dividend
Fraud Tip Form
Required Information
Please provide as much of the following as possible about the person you are reporting.
First Name:
Last Name:
Date Of Birth:
Where Does This Person Live?
Why is this person not eligible for the PFD program?
Last 4 digits of SSN:
Spouse's Name:
Children's Names:
Previous Addresses
How do you know this information?
Additional Information
May we contact you if we need additional information?
Yes, you may contact me if you need more information.
No, please do not contact me if you need more information.
Your Name:
Your Phone Number or Email:
Disclosure of Your Identity
I wish to remain anonymous - please do NOT disclose that you received this information from me.
I do NOT wish to remain anonymous - if necessary, you may disclose that you received this information from me.
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Please type the code above
Submit
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