Completed Form 4844, Request for Terminal Action for the tax period affected by the identity theft with the following information filled in: EIN – 00-XXXXXXX, Name control - XXXX, MFT code - 01, Periods - 201212, Name of taxpayer – XXX XXXXXXX XXXXX, Remarks- Input TC 971 AC 522 CLSIDT, Identity Theft Action Code - TC 971 AC 522, Miscellaneous Field Input – SB FC CLSIDT, Secondary Date Field- 11072013.