Product: Money transfer, virtual currency, or money service

Incident Location XXXX XXXX XXXX XXXX, XXXX, TX Incident Time ( start ) XX/XX/2022 XXXX AM Incident Time ( end ) XX/XX/2022 XXXX AM Location Type Other / Unknown clear img Narrative Incident Description ANY QUESTIONS LEFT UNANSWERED WILL DELAY THE PROCESSING OF YOUR REPORT. 

1. Is there an identified suspect? ( YES/NO ) No 2. Is the suspect someone familiar to you? No 3. What specific Fraud are you the victim of ( Romance Scheme, IRS Fraud, etc. )? 
XXXX XXXX XXXX XXXX ) 4. What records/bank statements/wire transfer information do you have to show you have been the victim of Fraud? 
I have transcripts of the emails and messages on XXXX as well as screenshots of the transactions 5. Is this report solely to satisfy your financial institution ( that you made a Police Report regarding the incident )? ( YES/NO ) No 6. Did this happen in XXXX XXXX XXXX XXXX ( YES/NO ) It happened on the internet but they gave me an XXXX address Complaint Referral Form Internet Crime Complaint Center Name : Are you reporting on behalf of a business? No Business Name : Is the incident currently impacting business operations? [ None ] County : Country : United States of America State : Massachusetts Email Address : XXXX Business IT POC, if applicable : Other Business POC, if applicable : Financial Transaction ( s ) Transaction Type : Virtual Currency If other, please specify : Transaction Amount : {$200.00} Transaction Date : XX/XX/2022 Was the money sent? Yes Victim Bank Name : Santander Bank Victim Bank Address : Victim Bank Address ( continued ) : Victim Bank Suite/Mail Stop : Victim Bank City : Victim Bank Country : [ None ] Victim Bank State [ None ] Victim Bank Zip Code/Route : Recipient Bank Name : XXXX Recipient Bank Address : Recipient Bank Address ( continued ) : Recipient Bank Suite/Mail Stop : Recipient Bank City : Recipient Bank Country : [ None ] Recipient Bank State [ None ] Recipient Bank Zip Code/Route : Recipient Name on Account : XXXX XXXX  Recipient Bank Routing Number : Recipient Account Number : XXXX Recipient Bank XXXX Code : Description of Incident Provide a description of the incident and how you were victimized. Provide information not captured elsewhere in this complaint form. 
This man scammed me out of XXXX dollars by persuading me to send him XXXX dollars as part of a refund that he claimed I owed him Which of the following were used in this incident? ( Check all that apply. ) Spoofed Email Similar Domain Email Intrusion OtherPlease specify : Law enforcement or regulatory agencies may desire copies of pertinent documents or other evidence regarding your complaint. 

Originals should be retained for use by law enforcement agencies. 

Information About The Subject ( s ) Who Victimized You Name : XXXX XXXX Business Name : Address : XXXX XXXX XXXXXXXX XXXX Address ( continued ) : Suite/Apt./Mail Stop : City : XXXX Country : United States of America State XXXX XXXX XXXX XXXX Zip Code/Route : XXXX Phone Number : XXXX Email Address : XXXX Website : IP Address : Other Information If an email was used in this incident, please provide a copy of the entire email including full email headers. 

XXXX XXXX Sun, XX/XX/XXXX, XXXX PM ( 3 days ago ) to me Santander Bank, N.A XXXX logo Dear XXXX, Just confirming that your payment to XXXX has finished processing. 

Payment Details Confirmation Number XXXX Amount {$200.00} From Santander Bank, N.A, CHECKING ( INTEREST BEARING ), XXXX To XXXX XXXX ( XXXX ) Message Refund As of XX/XX/2022, the money for this payment was removed from your account and credited to XXXX XXXX You can sign in to XXXX to view your activity. 

Thank you for using XXXX offered by Santander Bank, N.A. 

Respectfully yours, Santander Bank, N.A This email was sent to XXXX at XXXX. If you believe you have received this email in error, please call XXXX. 

To receive a copy of our privacy policy, please visit https : //www.santanderbank.com/us/privacy-policy. 

You received this service-related email because you sent money through XXXX. 

Email ID : XXXX XXXX. XXXX Mon, XX/XX/XXXX, XXXX PM ( 2 days ago ) to noreply XXXX XXXX XXXX Mon, XX/XX/XXXX, XXXX PM ( 2 days ago ) to me On Sun, XX/XX/2022 at XXXX PM XXXX XXXX XXXX wrote : XXXX XX/XX/2022 Transaction ID : XXXX Dear XXXX XXXX You received a payment of $ XXXX from XXXX XXXX Thanks for using XXXX. You can now ship any items. 
It may take a few moments for this transaction to appear in your account. 
This item is eligible for Seller Protection. 
Don't forget to : Send the item to the buyer 's shipping address. 
Please note : Items delivered in person or to a different address are not covered by Seller Protection. 
Use a trackable proof of delivery. 


Note : The payment is currently PENDING as it awaits shipment verification. Once order has been confirmed and item ( s ) shipped to the correct address, the money should be in your available balance within a short period of time after shipment has been verified. You are required to process the shipment immediately and reply to this email with the shipment tracking details and proof of postage for verification before the money will appear on your available balance. This will help us continue to be a safer way to buy and sell. 

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Buyer XXXX XXXX XXXX Note to seller Please ship XXXX, XXXX or USPS Standard Delivery Delivery address confirmed XXXXXXXX XXXX  XXXX XXXX XXXX XXXX TX XXXX Dispatch details You havent added any dispatch details. 
REPAYMENTS THAT KEEP PACE WITH YOUR SALES. APPLY NOW FOR XXXX XXXX XXXX. 

Description Unit price Qty Amount $ XXXX XXXX $ XXXX Postage and packaging {$0.00} USD Insurance - not offered -- -- Total {$300.00} USD Payment {$300.00} USD Payment sent to : XXXX XXXX XXXX Questions? Go to the Help Center at : XXXX Please do reply to this email to get in touch with us with the shipment tracking number for verification. 
You can choose to receive plain text emails instead of HTML emails. To change your Notifications preferences, log in to your account, go to your Profile, and click My setting XXXX XXXX XXXX Sun, XX/XX/XXXX, XXXX PM ( 16 hours ago ) to me -- -- -- -- -- Forwarded message -- -- -- -- - From : XXXX Services XXXX Date : Sun, XX/XX/2022 at XXXX PM Subject : Re : *****Notification Of An Instant Payment Of $ XXXX From XXXX XXXX ***** To : XXXX XXXX XXXX XXXX This transaction is safe and secured that either the payer or payee will not lose any funds because its already recorded on our data base.this is the final step to take refund the extra {$200.00} to the buyer and email us back with the screenshot so we can complete the transaction and release the total sum of {$700.00} to your account immediately.we care about the safety of our customers! 

On Mon, XXXX XX/XX/2022 at XXXX AM, XXXX XXXX XXXX wrote : The buyer was debited twice we found out that on our data base on the process of crediting your account with the total sum of {$500.00} so you now have a pending payment of {$700.00} kindly refund back the extra {$200.00} to the buyer and email us with a screenshot so we can release the whole {$700.00} to your account immediately without any further delay! 

On Mon, XXXX XX/XX/2022 at XXXX AM, XXXX XXXX XXXX wrote : Dear XXXX XXXX We apologize for the late response as we were upgrading our server which has now been sorted out. We have successfully verified that We have received your refund of $ XXXX and it has been approved and forwarded to the buyer immediately. 

But on the verge of crediting the total pending payment of {$500.00} USD as we notified you earlier which was paid by the XXXX XXXX XXXX ( XXXX ), we looked through our database and found Are there any other witnesses or victims to this incident? 
[ No response provided ] If you have reported this incident to other law enforcement or government agencies, please provide the name, phone number, email, date reported, report number, etc. 
XXXX Mon, XX/XX/XXXX, XXXX PM ( 2 days ago ) to me A new entry to a form/survey has been submitted. 

Form Name : Contact the XXXX Police Department Date & Time : XX/XX/2022 XXXX PM Response # : XXXX Submitter ID : XXXX IP address : XXXX : XXXX : XXXX : XXXX Time to complete : XXXX min., XXXX sec. 

Survey Details Page 1 Call XXXX if you have an emergency or if you know of a threat to public safety. 
This form is for questions or comments only. We can not dispatch officers, initiate an investigation or take reports from information provided in this form. 
Do not use this form to provide updated information on a police report that you made online or that was taken by an officer. If you filed your report online, you can submit additional information the same way. 
This form is monitored during normal business hours, Monday through Thursday only. 

If you are with a law enforcement agency, please do not use this form to request officer assistance or contact. Call XXXX, option 2, or XXXX. 

To make a police report or request a welfare check, please call XXXX, option 2. We can not create a report from this form. Report a non-emergency crime ( file a report online ). 

To report criminal/illegal activity, suspected criminal/illegal activity, or to report additional information about a report already taken, please call XXXX, option 2. We can not create a report from this form. 

Call XXXX, option 2, if you need an officer. Again, we can not create a report from this form. 

If you need to report an abandoned vehicle, please use the Abandoned Vehicle form. 

If you are requesting a copy of a police report, please use our online request portal or you may request a report in person at XXXX XXXX XXXX, Monday - Thursday, XXXX to XXXX. Same day service is not available. 

THIS IS NOT A COMPLAINT FORM. How to file a complaint. 

NOISE Complaints : If you have a complaint about noise in your neigh Check here if this an update to a previously filed complaint : Who Filed the Complaint Were you the victim in the incident described above? Yes Digital Signature By digitally signing this document, I affirm that the information I provided is true and accurate to the best of my knowledge. I understand that providing false information could make me subject to fine, imprisonment, or both. ( Title 18, U.S. Code, Section 1001 ) Digital Signature : XXXX XXXX