CRIMINAL TAX MANUAL


INDICTMENT AND INFORMATION FORMS

 


26 U.S.C. § 6531

1  Complaint to Toll Statute of Limitations Under 26 U.S.C. § 6531


26 U.S.C. § 7201

2  Individual - Separate Return Attempt to Evade and Defeat Tax - Venue in District of Filing

3  Individual - Separate Return, Attempt to Evade and Defeat Tax Venue in District of Preparation

4  Individual - Joint Return, Attempt to Evade and Defeat Tax Venue in District of Filing

5  Individual - Joint Return, Attempt to Evade and Defeat Tax Venue in District of Preparation

6  Individual - Community Property Return Attempt to Evade and Defeat Tax

7  Individual - Community Property Return of Spouse Attempt to Evade and Defeat Tax

8  Individual - Attempt to Evade and Defeat Tax Acts Subsequent to Filing

9  Individual - Spies Evasion, No Return Filed Attempt to Evade and Defeat Tax, Affirmative Acts, Spies v. United States, 317 U.S. 492 (1943)

10  Individual - Spies Evasion (No Return Filed), Attempt to Evade and Defeat TaxHusband and Wife Codefendants - Community Property

11  Individual - Attempt to Evade and Defeat the Payment of Tax

12  Corporation, Officer, or Employee - Corporate Return Attempt to Evade and Defeat Corporate Tax

13  Corporation - Attempt to Evade and Defeat Corporate Tax Acts Subsequent to Filing

14  Sole Proprietorship or Partnership Employer's Quarterly Return Attempt to Evade and Defeat Federal Withholding and F.I.C.A. (Social Security Taxes)

15  Sole Proprietorship or Partnership - Excise Tax Return Attempt to Evade and Defeat Excise Tax


26 U.S.C. § 7202

16  Failure to Account for and Pay Over Withholding and F.I.C.A. (Social Security) Taxes

17  Failure to Account for and Pay Over Withholding and F.I.C.A. (Social Security) Taxes Sole Proprietorship

18  Failure to Pay Over Withholding and F.I.C.A. (Social Security) Taxes Sole Proprietorship

19  Failure to Truthfully Account for and Pay Over Withholding and F.I.C.A. (Social Security) Taxes Corporation


26 U.S.C. § 7203

20  Individual Return - Failure to File

21  Individual Return - Failure to File Filing Requirement Based on Joint Income of Taxpayer and Spouse where (1) Taxpayer and Spouse were entitled to file a joint return and (2) Had the Same Residence as Their Household at the Close of the Taxable Year

22  Individual Return - Failure to File Community Property State Alternative

23  Partnership Return - Failure to File

24  Corporation Return - Failure to File

25  Failure to File Individual - Information Return

26  Failure to File Individual - 26 U.S.C. § 6050I Returns Relating to Cash Received in Trade or Business

27  Failure to File Individual - 26 U.S.C. § 6050I Returns Relating to Cash Received in Trade or Business

28  Individual - Failure to Pay Tax

29  Failure to File-- Sole Proprietorship or Partnership Employer’s Quarterly Return

30  Sole Proprietorship or Partnership Employer’s Quarterly Return Failure to File - Tabular Form Information

31  Sole Proprietorship or Partnership Excise Tax Return - Failure to File


26 U.S.C. § 7204

32  Failure to Furnish Employee's Withholding Statement, Form W-2

33  Furnishing False and Fraudulent Employee's Withholding Statement, Form W-2

 

26 U.S.C. § 7205

34  False Withholding Allowance Certificate, Form W-4


26 U.S.C. § 7206(1)

35  Return, Statement, or Other Document Venue in District of Filing

36  Making and Subscribing a False Return, Statement, or Other Document Venue in District of Preparation and Signing

37  Making and Subscribing a False Return False Amount Not Specified - Open Ended Indictment

38  Making and Subscribing a False Return Failure to Disclose a Business

39  Individual - 26 U.S.C. 6050I Returns Relating to Cash Received in Trade or Business Filing False Return


26 U.S.C. § 7206(2)

40  Aiding and Assisting in the Preparation and Presentation of a False and Fraudulent Return, Statement, or Other Document

41  Aiding and Assisting in the Preparation and Presentation of False and Fraudulent Individual Income Tax Returns Containing False Deductions - Tabular Form Indictment


26 U.S.C. § 7206(4)

42  Removal or Concealment of Goods or Commodities With Intent to Evade or Defeat the Assessment or Collection of a Tax


26 U.S.C. § 7206(5)(A)

43  Concealment of Assets in Connection with a Compromise or Closing Agreement

 

26 U.S.C. § 7206(5)(B)

44  Withholding, Falsifying, or Destroying Records or Making a False Statement in Connection with a Compromise or Closing Agreement


26 U.S.C. § 7207

45  False Document Submitted to I.R.S. Venue in District Where Document Submitted

46  False Document Submitted to I.R.S. Venue in District of Mailing

47  False Documents Submitted to I.R.S. Venue in District Where Documents Submitted Tabular Form Information

48  False Documents Submitted to I.R.S. Venue in District of Mailing Tabular Form Information


26 U.S.C. § 7210

49  Failure to Appear in Response to Summons


26 U.S.C. § 7212(a) "Omnibus" Clause

50  Corrupt Endeavor to Obstruct or Impede the Due Administration of the Internal Revenue Laws


26 U.S.C. § 7215

51  Failure to Make Trust Fund Deposit After Notice


18 U.S.C. § 287

52  False Claim for Refund


18 U.S.C. § 286/287

53  Conspiracy to File False Claims for Refund/False Claims for Refund


18 U.S.C. § 371

54  Conspiracy To Defraud United States Impede And Impair I.R.S. -- Klein Conspiracy


18 U.S.C. § 1001

55  False Statement or Representation Made to Department/Agency of U.S.

56  False Document Submitted to Department/Agency of U.S.

57  Falsify, Conceal, or Cover Up by Trick, Scheme, or Device a Material Fact


18 U.S.C. § 1956(a)(1)(A)(ii)

58  Laundering of Monetary Instruments



[F-1]

Form 1


Complaint to Toll Statute of Limitations

Under 26 U.S.C. § 6531


IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF _____________


UNITED STATES OF AMERICA )  
)  
v.
) COMPLAINT
  )  
_____________________ )  


                      COMPLAINT FOR VIOLATION OF SECTION 72011

                      INTERNAL REVENUE CODE OF 1986 (26 U.S.C.)


Before [Magistrate Judge's Name], United States Magistrate Judge,

[Judicial District].


            The undersigned complainant, being duly sworn, states:

            That he [she] is a Special Agent [or Revenue Agent] of the Internal Revenue Service and, in the performance of the duties imposed on him [her] by _________, he [she] has conducted an investigation of the Federal income tax liability of [Defendant's Name] of [City], [State], for the calendar year2 20 , by examining the taxpayer's tax return for the calendar year2 20 , and other years; [e.g., by examination and audit of the taxpayer's business and financial books and records; by identifying and interviewing third parties with whom the taxpayer did business; by consulting public and private records reflecting the taxpayer's income; and/or by interviewing third persons having knowledge of the taxpayer's financial condition.]3

            That based on this investigation, the complainant has personal knowledge that on or about the day of , 20 , at [City], [State] in the District of ________, [Defendant's Name] did unlawfully and willfully attempt to evade and defeat the income taxes due and owing by him [her]1 to the United States of America for the calendar year2 20 , by preparing and causing to be prepared, and by signing and causing to be signed in the District of       , a false and fraudulent U.S. Individual Income Tax Return, Form 1040, which was filed with the Internal Revenue Service. In that return, [Defendant's Name] stated that his [her] taxable4 [or adjusted gross] income for the calendar year2 20 was $     , and that the amount of tax due and owing thereon was the sum of $ , when in fact, as he [she] knew, his [her] taxable4 [or adjusted


[F-2] gross] income for the calendar year2 was the sum of $ , upon which taxable4 [or adjusted gross] income he [she] owed to the United States of America an income tax of $ .

                                                                                                     5

                                                                 Title of Subscribing Internal

                                                                 Revenue Service Officer


            Sworn to before me and subscribed in my presence, this day of ,

20 .


                                                                                               

                                                                 United States Magistrate



NOTES


1 When drafting complaints for violation of other Sections of the Internal Revenue Code, refer to the appropriate indictment form as a guide.


2 If a fiscal year is involved, substitute "fiscal year ended , 20 ". Fiscal year individual returns must be filed on or before the 15th day of the fourth month after the end of the fiscal year. 26 U.S.C. § 6072(a).


3 The bracketed descriptions of the kinds of investigation conducted by the subscribing agent may all be used if they correctly reflect the facts. Otherwise, the inapposite description(s) should, of course, be deleted. When appropriate, the description of a different investigative course should be added or substituted based on the facts. See Jaben v. United States, 381 U.S. 214 (1965).


4 Forms 1040 for some years do not use the phrase "taxable income" or "tax table income." However, what constitutes taxable income as defined in 26 U.S.C. § 63, is actually computed on the appropriate line of the return. That line may vary, and the line on the return showing the amount on which the actual tax was computed should be used.


5 To be sworn to by an Internal Revenue Service Officer having knowledge of the facts.


[F-3]

Form 2


26 U.S.C. § 7201

Individual - Separate Return

Attempt to Evade and Defeat Tax

Venue in District of Filing



IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF


UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7201
________________________ )  

 

            The grand jury charges:

            That on or about the [Month] [Day], [Year], in the                  District of                  , [Defendant's Name], a resident of [City], [State], did willfully attempt to evade and defeat a large part of the income tax due and owing by him [her] to the United States of America for the calendar year1 20 , by filing and causing to be filed with the Director, Internal Revenue Service Center, at [City], [State],2 a false and fraudulent U.S. Individual Income Tax Return, Form 1040. In that false return, [Defendant's Name] stated that his [her] taxable income3 for the calendar year1 20 , was the sum of $ , and that the amount of tax due and owing thereon was the sum of $ . In fact, as he [she] then and there knew, his [her] taxable income3 for the calendar year1 was the sum of $ , upon which taxable income3 there was owing to the United States of America an income tax of $ .4

            In violation of Title 26, United States Code, Section 7201.

                                                                 A True Bill.

 

                                                                                      

                                                                 Foreperson


                              

United States Attorney


[F-4]

NOTES


1 If a fiscal year is involved, substitute "fiscal year ended , 20 ". Fiscal year individual returns must be filed on or before the 15th day of the fourth month after the end of the fiscal year. 26 U.S.C. § 6072(a).


2 When appropriate, substitute "by filing and causing to be filed with the person assigned to receive returns at the local office of the Internal Revenue Service at [City], [State]".


3 Forms 1040 for some years do not use the phrase "taxable income" or "tax table income." However, what constitutes taxable income as defined in 26 U.S.C. § 63 is actually computed on the appropriate line of the return. That line may vary, and the line on the return showing the amount on which the actual tax was computed should be used.


4 If it is determined that unreported income and tax are not to be numerically alleged in the indictment, then substitute "In fact, as he [she] then and there knew, his [her] taxable income for the calendar year was substantially in excess of the amount stated on the return, and, upon the additional taxable income, a substantial additional tax was due and owing to the United States of America." See United States v. Citron, 783 F.2d 307, 314-15 (2d Cir. 1986); United States v. Buckner, 610 F.2d 570, 573 (9th Cir. 1979), cert. denied, 445 U.S. 961 (1980). Note, however, that the Ninth Circuit has ruled that a "substantial" additional tax is not required; all that is required in that circuit is some additional tax. United States v. Marashi, 913 F.2d 724, 736 (9th Cir. 1990).


[F-5]

Form 3


26 U.S.C. § 7201

Individual - Separate Return

Attempt to Evade and Defeat Tax

Venue in District of Preparation


IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF

 

UNITED STATES OF AMERICA )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7201
___________________________ )  


            The grand jury charges:

            That on or about [Month] [Day], [Year], in the District of ________, [Defendant's Name], a resident of [City], [State], did willfully attempt to evade and defeat a large part of the income tax due and owing by him [her] to the United States of America for the calendar year1 20__ , by preparing and causing to be prepared, and by signing and causing to be signed,2 a false and fraudulent U.S. Individual Income Tax Return, Form 1040, which was filed with the Internal Revenue Service. In that false income tax return, he [she] stated that his [her] taxable income3 for the calendar year1 was the sum of $ , and that the amount of tax due and owing thereon was the sum of $ . In fact, as he [she] then and there knew, his [her] taxable income3 for the calendar year1 was the sum of $ , upon which taxable income3 there was owing to the United States of America an income tax of $ .4

            In violation of Title 26, United States Code, Section 7201.

                                                                 A True Bill.

                                                                                      

                                                                 Foreperson


                              

United States Attorney


[F-6]

NOTES


1 If a fiscal year is involved, substitute "fiscal year ended , 20 ". Fiscal year individual returns must be filed on or before the 15th day of the fourth month after the end of the fiscal year. 26 U.S.C. § 6072(a).


2 Where venue is based on mailing, substitute "by mailing and causing to be mailed".


3 Forms 1040 for some years do not use the phrase "taxable income" or "tax table income". However, what constitutes taxable income as defined in 26 U.S.C. § 63 is actually computed on the appropriate line of the return. That line may vary, and the line on the return showing the amount on which the actual tax was computed should be used.


4 If it is determined that unreported income and tax are not to be numerically alleged in the indictment, then substitute "In fact, as he [she] then and there knew, his [her] taxable income for the calendar year was substantially in excess of the amount stated on the return, and, upon the additional taxable income, a substantial additional tax was due and owing to the United States of America." See United States v. Citron, 783 F.2d 307, 314-15 (2d Cir. 1986); United States v. Buckner, 610 F.2d 570, 573 (9th Cir. 1979), cert. denied, 445 U.S. 961 (1980). Note, however, that the Ninth Circuit has ruled that a "substantial" additional tax is not required; all that is required in that circuit is some additional tax. United States v. Marashi, 913 F.2d 724, 736 (9th Cir. 1990).


[F-7]

Form 4


26 U.S.C. § 7201

Individual - Joint Return

Attempt to Evade and Defeat Tax

Venue in District of Filing


IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF


UNITED STATES OF AMERICA )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7201
___________________________ )  

 

            The grand jury charges:

            That on or about [Month] [Day], [Year], in the District of

                       [Defendant's Name], a resident of [City], [State], who during the calendar year1 20__ was married, did willfully attempt to evade and defeat a large part of the income tax due and owing by him [her] and his [her] spouse to the United States of America for the calendar year1 20__ , by filing and causing to be filed with the Director, Internal Revenue Service Center, at [City], [State],2 a false and fraudulent joint U.S. Individual Income Tax Return, Form 1040, on behalf of himself [herself] and his [her] spouse. In that false return, it was stated that the joint taxable income3 of [Defendant's Name] and his [her] spouse for the calendar year1 was the sum of $ and that the amount of tax due and owing thereon was the sum of $ . In fact, as he [she] then and there knew, their joint taxable income3 for the calendar year1 was the sum of $ , upon which joint taxable income3 there was owing to the United States of America an income tax of $ .4

            In violation of Title 26, United States Code, Section 7201.

                                                                 A True Bill.

                                                                                          

                                                                 Foreperson


                             

United States Attorney

 


[F-8]

NOTES



1 If a fiscal year is involved, substitute "fiscal year ended , 20__". Fiscal year individual returns must be filed on or before the 15th day of the fourth month after the end of the fiscal year. 26 U.S.C. § 6072(a).


2 When appropriate, substitute "with the person assigned to receive returns at the local office of the Internal Revenue Service at [City], [State]".


3 Forms 1040 for some years do not use the phrase "taxable income" or "tax table income". However, what constitutes taxable income as defined in 26 U.S.C. § 63 is actually computed on the appropriate line of the return. That line may vary, and the line on the return showing the amount on which the actual tax was computed should be used.


4 If it is determined that unreported income and tax are not to be numerically alleged in the indictment, then substitute "In fact, as he [she] then and there knew, their joint taxable income for the calendar year was substantially in excess of the amount stated on the return, and, upon the additional taxable income, a substantial additional tax was due and owing to the United States of America." See United States v. Citron, 783 F.2d 307, 314-15 (2d Cir. 1986); United States v. Buckner, 610 F.2d 570, 573 (9th Cir. 1979), cert. denied, 445 U.S. 961 (1980). Note, however, that the Ninth Circuit has ruled that a "substantial" additional tax is not required; all that is required in that circuit is some additional tax. United States v. Marashi, 913 F.2d 724, 736 (9th Cir. 1990).


[F-9]

Form 5


26 U.S.C. § 7201

Individual - Joint Return

Attempt to Evade and Defeat Tax

Venue in District of Preparation


IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF


UNITED STATES OF AMERICA )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7201
___________________________ )  

 


            The grand jury charges:

            That on or about [Month] [Day], [Year], in the District of

                        , [Defendant's Name], a resident of [City], [State], who during the calendar

year1 20__ was married, did willfully attempt to evade and defeat a large part of the income tax due and owing by him [her] and his [her] spouse to the United States of America for the calendar year1 20__, by preparing and causing to be prepared, and by signing and causing to be signed,2 a false and fraudulent joint U.S. Individual Income Tax Return, Form 1040, on behalf of himself [herself] and his [her] spouse, which was filed with the Internal Revenue Service. In that return, it was stated that their joint taxable income3 for the calendar year1 was the sum of $ and that the amount of tax due and owing thereon was the sum of $ . In fact, as he [she] then and there knew, their joint taxable income3 for the calendar year1 was the sum of $ , upon which joint taxable income3 there was owing to the United States of America an income tax of $ .4

            In violation of Title 26, United States Code, Section 7201.

                                                                 A True Bill.

 

                                                                                          

                                                                 Foreperson

                             

United States Attorney



[F-10]

NOTES


1 If a fiscal year is involved, substitute "fiscal year ended , 20__". Fiscal year individual returns must be filed on or before the 15th day of the fourth month after the end of the fiscal year. 26 U.S.C. § 6072(a).


2 If venue is based on mailing, substitute "by mailing and causing to be mailed".


3 Forms 1040 for some years do not use the phrase "taxable income" or "tax table income". However, what constitutes taxable income as defined in 26 U.S.C. § 63 is actually computed on the appropriate line of the return. That line may vary, and the line on the return showing the amount on which the actual tax was computed should be used.


4 If it is determined that unreported income and tax are not to be numerically alleged in the indictment, then substitute "In fact, as he [she] then and there knew, their taxable income for the calendar year was substantially in excess of the amount stated on the return, and, upon the additional taxable income, a substantial additional tax was due and owing to the United States of America." See United States v. Citron, 783 F.2d 307, 314-15 (2d Cir. 1986); United States v. Buckner, 610 F.2d 570, 573 (9th Cir. 1979), cert. denied, 445 U.S. 961 (1980). Note, however, that the Ninth Circuit has ruled that a "substantial" additional tax is not required; all that is required in that circuit is some additional tax. United States v. Marashi, 913 F.2d 724, 736 (9th Cir. 1990).


[F-11]

Form 6


26 U.S.C. § 7201

Individual - Community Property Return

Attempt to Evade and Defeat Tax



IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF


UNITED STATES OF AMERICA )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7201
___________________________ )  

            The grand jury charges:

            That on or about [Month] [Day], [Year], in the District of

                 , [Defendant's Name], a resident of [City], [State], did willfully attempt to evade and defeat a large part of the income tax due and owing by him [her] to the United States of America for the calendar year1 20__, by preparing and causing to be prepared, and by signing and causing to be signed,2 a false and fraudulent U.S. Individual Income Tax Return, Form 1040, which was filed with the Internal Revenue Service. In that return, he [she] stated that his [her] taxable income3 for calendar year,1 computed on the community property basis, was the sum of $ and that the amount of tax due and owing thereon was the sum of $ . In fact, as he [she] then and there knew, his [her] taxable income3 for the calendar year1, computed on the community property basis, was the sum of $ , upon which taxable income3 there was owing to the United States of America an income tax of $ .4

            In violation of Title 26, United States Code, Section 7201.

                                                                 A True Bill.

                                                                                          

                                                                 Foreperson


                             

United States Attorney



[F-12]

NOTES


1 If a fiscal year is involved, substitute "fiscal year ended , 20__". Fiscal year individual returns must be filed on or before the 15th day of the fourth month after the end of the fiscal year. 26 U.S.C. § 6072(a).


2 If venue is to be placed in the judicial district in which the return was filed, modify this form in accordance with language in Form 2 and related footnote 2. If venue is based on mailing, substitute "by mailing and causing to be mailed".


3 Forms 1040 for some years do not use the phrase "taxable income" or "tax table income". However, what constitutes taxable income as defined in 26 U.S.C. § 63 is actually computed on the appropriate line of the return. That line may vary and the line on the return showing the amount on which the actual tax was computed should be used.


4 If it is determined that unreported income and tax are not to be numerically alleged in the indictment, then substitute "In fact, as he [she] then and there knew, his [her] taxable income for the calendar year was substantially in excess of the amount stated on the return, and, upon the additional taxable income, a substantial additional tax was due and owing to the United States of America." See United States v. Citron, 783 F.2d 307, 314-15 (2d Cir. 1986); United States v. Buckner, 610 F.2d 570, 573 (9th Cir. 1979), cert. denied, 445 U.S. 961 (1980). Note, however, that the Ninth Circuit has ruled that a "substantial" additional tax is not required; all that is required in that circuit is some additional tax. United States v. Marashi, 913 F.2d 724, 736 (9th Cir. 1990).


[F-13]

Form 7


26 U.S.C. § 7201

Individual - Community Property Return of Spouse

Attempt to Evade and Defeat Tax


IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF


UNITED STATES OF AMERICA )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7201
___________________________ )  

            The grand jury charges:

            That on or about [Month] [Day], [Year], in the District of

                       , [Defendant's Name], a resident of [City], [State], who during the calendar

year1 20__, was married to [Name of Spouse], did willfully attempt to evade and defeat a large part of the income tax due and owing by [Name of Spouse] to the United States of America for the calendar year1 20__, by preparing and causing to be prepared, and by signing and causing to be signed,2 a false and fraudulent U.S. Individual Income Tax Return, Form 1040, which was filed with the Internal Revenue Service for and on behalf of [Name of Spouse]. In that false return, it was stated that his [her] taxable income3 for said calendar year1, computed on the community property basis, was the sum of $ and that the amount of tax due and owing thereon was the sum of $ . In fact, as [Defendant's Name] then and there knew, the taxable income3 of [Name of Spouse] for the calendar year1, computed on the community property basis, was the sum of $ , upon which taxable income3 there was owing to the United States of America an income tax of $ .4

            In violation of Title 26, United States Code, Section 7201.

                                                                 A True Bill.

                                                                                     

                                                                 Foreperson


                             

United States Attorney





[F-14]

NOTES


1 If a fiscal year is involved, substitute "fiscal year ended , 20__". Fiscal year individual returns must be filed on or before the 15th day of the fourth month after the end of the fiscal year. 26 U.S.C. § 6072(a).


2 If venue is to be placed in the judicial district in which the return was filed, modify this form in accordance with language in Form 2 and related Footnote 2. If venue is based on mailing, substitute "by mailing and causing to be mailed".


3 Forms 1040 for some years do not use the phrase "taxable income" or "tax table income". However, what constitutes taxable income, as defined in 26 U.S.C. § 63, is actually computed on the appropriate line of the return. That line may vary and the line on the return showing the amount on which the actual tax was computed should be used.


4 If it is determined that unreported income and tax are not to be numerically alleged in the indictment, then substitute "In fact, as he [she] then and there knew, [Name of Spouse]'s taxable income for the calendar year was substantially in excess of the amount stated on the return, and, upon the additional taxable income, a substantial additional tax was due and owing to the United States of America." See United States v. Citron, 783 F.2d 307, 314-15 (2d Cir. 1986); United States v. Buckner, 610 F.2d 570, 573 (9th Cir. 1979), cert. denied, 445 U.S. 961 (1980). Note, however, that the Ninth Circuit has ruled that a "substantial" additional tax is not required; all that is required in that circuit is some additional tax. United States v. Marashi, 913 F.2d 724, 736 (9th Cir. 1990).


[F-15]

Form 8


26 U.S.C. § 7201

Individual - Attempt to Evade and Defeat Tax

Acts Subsequent to Filing


IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF


UNITED STATES OF AMERICA )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7201
___________________________ )  

            The grand jury charges:

            That on or about [Month] [Day], [Year], in the District of

                      , [Defendant's Name], a resident of [City], [State], did willfully attempt to evade and defeat a large part of the income tax due and owing by him [her] to the United States of America for the calendar year1 20__, by [Describe Act or Acts, e.g., Filing False Financial Statement, or Making False Statements or Representations to Employees of the Internal Revenue Service, etc. See Spies v. United States, 317 U.S. 492 (1943)], for the purpose of concealing additional unreported taxable income received by [Defendant's Name] during the calendar year.1 On that unreported taxable income, as he [she] then and there knew, there was due and owing to the United States of America an income tax of $ [Insert Amount of Tax Deficiency, Not Total Tax].2 

            In violation of Title 26, United States Code, Section 7201.

                                                                 A True Bill.

 

                                                                                     

                                                                 Foreperson

                             

United States Attorney




[F-16]

NOTES


1 If a fiscal year is involved, substitute "fiscal year ended , 20__". Fiscal year individual returns must be filed on or before the 15th day of the fourth month after the end of the fiscal year. 26 U.S.C. § 6072(a).


2 If it is determined that unreported tax is not to be numerically alleged in the indictment, then delete "an income tax of $ " and substitute "a substantial additional income tax." See United States v. Citron, 783 F.2d 307, 314-15 (2d Cir. 1986); United States v. Buckner, 610 F.2d 570, 573 (9th Cir. 1979), cert. denied, 445 U.S. 961 (1980). Note, however, that the Ninth Circuit has ruled that a "substantial" additional tax is not required; all that is required in that circuit is some additional tax. United States v. Marashi, 913 F.2d 724, 736 (9th Cir. 1990).


[F-17]

Form 9


26 U.S.C. § 7201

Individual - Spies Evasion, No Return Filed

Attempt to Evade and Defeat Tax, Affirmative Acts,

Spies v. United States, 317 U.S. 492 (1943)

 


IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF


UNITED STATES OF AMERICA )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7201
___________________________ )  

            

The grand jury charges:

            During the calendar year1 20__, [Defendant's Name], a resident of [City], [State], had and received taxable income2 in the sum of $___ . Upon that taxable income,2 there was owing to the United States of America an income tax of $___ . Well knowing and believing the foregoing facts, and failing to make an income tax return on or before April 15, 20___    ,3 as required by law, to any proper officer of the Internal Revenue Service, and pay to the Internal Revenue Service the income tax, [Defendant's Name], on or about [Date(s) of affirmative acts], in the             District of ________, did willfully attempt to evade and defeat the income tax due and owing by him [her] to the United States of America for the calendar year1 by [set forth the affirmative act(s) of evasion -- not omissions -- such as concealing and attempting to conceal from all proper officers of the United States of America his [her] true and correct income].4

            In violation of Title 26, United States Code, Section 7201.

                                                                 A True Bill.

                                                                                           

                                                                 Foreperson


                             

United States Attorney




[F-18]

NOTES


1 If a fiscal year is involved, substitute "fiscal year ended , 20__". Fiscal year individual returns must be filed on or before the 15th day of the fourth month after the end of the fiscal year. 26 U.S.C. § 6072(a).


2 For the definition of taxable income, see 26 U.S.C. § 63. Note also 26 U.S.C. § 61, et seq.


3 Note that if April 15th fell on a Saturday, Sunday, or legal holiday, the filing date to charge in the indictment would be the next succeeding day that was not a Saturday, Sunday, or legal holiday. Note also that the date the return was due should include any authorized extensions of time for filing. 26 U.S.C. 7503.


4 See Spies v. United States, 317 U.S. 492, 499 (1943). In United States v. Edwards, 777 F.2d 644, 650 (11th Cir. 1985), cert. denied, 475 U.S. 1123 (1986), the court held that concealing or attempting to conceal income constitutes an affirmative act of tax evasion. See also United States v. Nelson, 791 F.2d 336, 338 n.3 (5th Cir. 1986), for a list of cases approving indictments charging concealing and attempting to conceal as an affirmative act of evasion.


[F-19]

Form 10


26 U.S.C. § 7201

Individual - Spies Evasion (No Return Filed)

Attempt to Evade and Defeat Tax

Husband and Wife Codefendants - Community Property



IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF


UNITED STATES OF AMERICA )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7201
___________________________ )  

            

The grand jury charges:

            During the calendar year1 20__, the defendants [Husband's Name] and [Wife's Name], who were husband and wife, and who were residents of [City], [State], had and received taxable income,2 computed on the community property basis, in the sum of $___ and $___ , respectively. Upon that taxable income2 there was owing to the United States of America by the defendants income taxes of $ ___ and $___       ,3 respectively. Well knowing and believing the foregoing facts, and failing to make separate individual income tax returns or a joint individual income tax return on or before April 15, 20__,4 as required by law, to any proper officer of the Internal Revenue Service, and pay to the Internal Revenue Service the income taxes, [Husband's Name] and [Wife's Name], on or about April 15, 20__    ,4 in the District of ________, did willfully attempt to evade and defeat the income taxes due and owing5 by them to the United States of America for the calendar year1 by [Set Forth the Affirmative Act(s) of Evasion -- Not Omissions -- Done by or on Behalf of Each Defendant, Such as Concealing and Attempting to Conceal from all Proper Officers of the United States of America his [her] [their] True and Correct Income; See Spies v. United States, 317 U.S. 492, 499 (1943)].

            In violation of Title 26, United States Code, Section 7201.

                                                                  A True Bill.

 

                                                                                           

                                                                 Foreperson


                             

United States Attorney



[F-20]

NOTES


1 If a fiscal year is involved, substitute "fiscal year ended , 20__". Fiscal year individual returns must be filed on or before the 15th day of the fourth month after the end of the fiscal year. 26 U.S.C. § 6072(a).


2 For the definition of taxable income, see 26 U.S.C. § 63. Note also 26 U.S.C. §§ 61, et seq.


3 Include total tax liability, without regard to wage withholding.


4 Note that if April 15th fell on a Saturday, Sunday, or legal holiday, the filing date to charge in the indictment would be the next succeeding day that was not a Saturday, Sunday, or legal holiday. Note also that the date the return was due should include any authorized extensions of time for filing. 26 U.S.C. § 7503.


5 If there has been income tax withholding, add before " the income taxes", either "a substantial part of", "a large part of", "a part of", or "a portion of".


6 In United States v. Edwards, 777 F.2d 644, 650 (11th Cir. 1985), cert. denied, 475 U.S. 1123 (1986), the court held that concealing or attempting to conceal income constitutes an affirmative act of tax evasion. See also United States v. Nelson, 791 F.2d 336, 338 n.3 (5th Cir. 1986), for a list of cases approving indictments charging concealing and attempting to conceal as an affirmative act of evasion.

 


[F-21]

Form 11


26 U.S.C. § 7201

Individual - Attempt to Evade

and Defeat the Payment of Tax


IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF


UNITED STATES OF AMERICA )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7201
___________________________ )  

            The grand jury charges:

            That on or about [Month] [Day], [Year], 1 in the District of

                , [Defendant's Name], a resident of [City], [State], did willfully attempt to evade and defeat the payment of a large part of the income tax due and owing by him [her] to the United States of America for the calendar year2 20__, in the amount of $ , by [Set Forth the Affirmative Acts Constituting the Willful Attempt, Such as the Following: Concealing and Attempting to Conceal From the Internal Revenue Service the Nature and Extent of His [her] Assets and the Location Thereof; Making False Statements to Agents of the Internal Revenue Service; Placing Funds and Property in the Names of Nominees; Placing Funds and Property Beyond the reach of process; etc.].3

            In violation of Title 26, United States Code, Section 7201.

                                                                 A True Bill.

 

                                                                                          

                                                                 Foreperson


                             

United States Attorney




[F-22]

NOTES


1 The Seventh Circuit has held that an indictment may use the April 15th return due date, even though not all the acts of evasion of payment occurred on that date. See United States v. Conley, 826 F.2d 551, 558-559 (7th Cir. 1987). Moreover, the "attempt" may consist of a course of conduct. If it does, substitute "on or about the day of , 20__, and continuing to ".


2 If a fiscal year is involved, substitute "fiscal year ended , 20__"; if more than one year's tax is involved, substitute "for the years through ". Fiscal year individual returns must be filed on or before the 15th day of the fourth month after the end of the fiscal year. 26 U.S.C. § 6072(a).


3 In United States v. Edwards, 777 F.2d 644, 650 (11th Cir. 1985), cert. denied, 475 U.S. 1123 (1986), the court held that concealing or attempting to conceal income constitutes an affirmative act of tax evasion. See also United States v. Nelson, 791 F.2d 336, 338 n.3 (5th Cir. 1986), for a list of cases approving indictments charging concealing and attempting to conceal as an affirmative act of evasion.


[F-23]

Form 12


26 U.S.C. § 7201

Corporation, Officer, or Employee - Corporate Return

Attempt to Evade and Defeat Corporate Tax



IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF


UNITED STATES OF AMERICA )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7201
___________________________ )  


            The grand jury charges:

            That on or about [Month] [Day], [Year], in the District of

                         , [Defendant's Name],1 who was the [Position Held in Corp.] of [Name of Corporation], a corporation, did willfully attempt to evade and defeat a large part of the income tax due and owing by the corporation to the United States of America for the calendar year2 20__, by preparing and causing to be prepared, and by signing and causing to be signed,3 a false and fraudulent U.S. Corporation Income Tax Return, Form 1120, which was filed with the Internal Revenue Service on behalf of the corporation. In that false return, it was reported that the taxable income of the corporation for the calendar year2 was the sum of $ and that the total amount of tax due and owing thereon was the sum of $ . In fact, as he [she] [it] then and there knew, the taxable income of [Name of Corporation] for the calendar year2 20__, was the sum of $ , upon which taxable income there was due and owing to the United States of America a total tax of $ .4

            In violation of Title 26, United States Code, Section 7201.

                                                                 A True Bill.

                                                                                          

                                                                 Foreperson


                             

United States Attorney





[F-24]

NOTES


1 If the corporation is named as the defendant, substitute the name of the corporation.


2 If a fiscal year is involved, substitute "fiscal year ended , 20__".


3 If venue is to be placed in the judicial district in which the return was filed, modify this form in accordance with language in Form 2 and related Footnote 2. If venue is based on mailing, substitute "by mailing and causing to be mailed".


4 If it is determined that unreported income and tax are not to be numerically alleged in the indictment, then substitute "In fact, as he [she] [it] then and there knew, the taxable income of the corporation for the calendar year was substantially in excess of the amount stated on the return, and, upon the additional taxable income, a substantial additional tax was due and owing to the United States of America." See United States v. Citron, 783 F.2d 307, 314-15 (2d Cir. 1986); United States v. Buckner, 610 F.2d 570, 573 (9th Cir. 1979), cert. denied, 445 U.S. 961 (1980). Note, however, that the Ninth Circuit has ruled that a "substantial" additional tax is not required; all that is required in that circuit is some additional tax. United States v. Marashi, 913 F.2d 724, 736 (9th Cir. 1990).


[F-25]

Form 13


26 U.S.C. § 7201

Corporation - Attempt to Evade and Defeat Corporate Tax

Acts Subsequent to Filing



IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF


UNITED STATES OF AMERICA )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7201
___________________________ )  

            The grand jury charges:

            That on or about [Month] [Day], [Year], in the District of

                             , [Defendant's Name]1 who was the [Position Held in Corp.] of [Name of Corporation], a corporation, did willfully attempt to evade and defeat a large part of the income tax due and owing by the corporation to the United States of America for the calendar year2 20__, by [Describe Act or Acts; e.g., Filing False Financial Statement, Making False Statements and Representations to Employees of the Internal Revenue Service, etc. See Spies v. United States, 317 U.S. 492 (1943)], for the purpose of concealing additional unreported taxable income received by the corporation during the calendar year2, on which unreported taxable income, as he [she] [it] then and there knew, there was due and owing to the United States of America an income tax of $ . [Insert Amount of Corporation's Tax Deficiency, Not Total Tax].3

            In violation of Title 26, United States Code, Section 7201.

                                                                 A True Bill.

 

                                                                                          

                                                                 Foreperson


                             

United States Attorney





[F-26]

NOTES


1 If the corporation is named as the defendant, substitute the name of the corporation.


2 If a fiscal year is involved, substitute "fiscal year ended , 20__".


3 If it is determined that unreported tax is not to be numerically alleged in the indictment, then delete "an income tax of $ " and substitute "a substantial additional tax". See United States v. Citron, 783 F.2d 307, 314-15 (2d Cir. 1986); United States v. Buckner, 610 F.2d 570, 573 (9th Cir. 1979), cert. denied, 445 U.S. 961 (1980). Note, however, that the Ninth Circuit has ruled that a "substantial" additional tax is not required; all that is required in that circuit is some additional tax. United States v. Marashi, 913 F.2d 724, 736 (9th Cir. 1990).


[F-27]

Form 14


26 U.S.C. § 7201

Sole Proprietorship or Partnership

Employer's Quarterly Return

Attempt to Evade and Defeat

Federal Withholding and F.I.C.A. (Social Security Taxes)



IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF


UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7201
________________________ )  

            The grand jury charges:

            That on or about [Month] [Day], [Year], in the District of

               , [Defendant's Name], a resident of [City], [State], who conducted a business1 as a [Sole Proprietorship or Partnership] under the name , with its principal place of business in [City], [State], did willfully attempt to evade and defeat a large part of the federal income taxes withheld from wages and Federal Insurance Contributions Act taxes due and owing to the United States of America for the quarter ending , 20__, by preparing and causing to be prepared, and by signing and causing to be signed,2 a false and fraudulent Employer's Quarterly Federal Tax Return, Form 941, which was filed with the Internal Revenue Service, wherein it was stated that the total wages subject to withholding paid to employees by [Name of Business] for the quarter was the sum of $ and that the total amount of federal income tax withheld and social security taxes due and owing thereon was the sum of $ . In fact, as he [she] [it] then and there knew, the total wages subject to withholding paid to employees for the quarter was the sum of $ , upon which wages there were due and owing to the United States of America federal income taxes withheld from wages and social security taxes in the total amount of $ .

            In violation of Title 26, United States Code, Section 7201.

                                                                 A True Bill.

 

                                                                                          

                                                                 Foreperson


                             

United States Attorney



[F-28]

NOTES


1 If the employer is a corporation, refer to Form 13 as a guide in charging appropriate corporate officials with an offense involving violation of a corporation's obligations under the law.


2 If venue is to be placed in judicial district in which the return was filed, modify this form in accordance with language in Form 2 and related Footnote 2. If venue is based on mailing, substitute "by mailing and causing to be mailed".


[F-29]

Form 15


26 U.S.C. § 7201

Sole Proprietorship or Partnership - Excise Tax Return

Attempt to Evade and Defeat Excise Tax



IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF


UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7201
________________________ )  

 


            The grand jury charges:

            That on or about [Month] [Day], [Year], in the District of

                   , [Defendant's Name],1 a resident of [City], [State], who conducted a retail2 business as a [Sole Proprietorship or Partnership] under the name , with its principal place of business in [City], [State], did willfully attempt to evade and defeat a large part of the retail dealer's3 excise tax on [Article], imposed by Section of the Internal Revenue Code (Title 26), due and owing to the United States of America for the quarter ending4 , 20__. He [she] [it] made that willful attempt, by preparing and causing to be prepared, and signing and causing to be signed,5 a false and fraudulent Quarterly Federal Excise Tax Return,6 which was filed with the Internal Revenue Service on behalf of the retail2 business. In that false return, it was stated that the excise tax due and owing to the United States of America by reason of the retail2 sale of [Article] for the quarter4 was the sum of $ . In fact, as he [she] [it] then and there knew, there was due and owing to the United States of America for the quarter,4 retail dealer's3 excise tax in the sum of $        .

            In violation of Title 26, United States Code, Section 7201.

                                                                 A True Bill.

 

                                                                                          

                                                                 Foreperson


                             

United States Attorney





[F-30]

NOTES


1 If a corporation is named as the defendant, substitute the name of the corporation.


2 Substitute other appropriate business type, e.g., manufacturing.


3 For other excise taxes, see 26 U.S.C. § 4041, et seq.


4 Designate appropriate period.


5 If venue is to be placed in the judicial district in which the return was filed, modify this form in accordance with language in Form 2 and related Footnote 2. If venue is based on mailing, substitute "by mailing and causing to be mailed".


6 Designate appropriate IRS form.


[F-31]

Form 16


26 U.S.C. § 7202

Failure to Account for and Pay Over

Withholding and F.I.C.A. (Social Security) Taxes



IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF


UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7202
________________________ )  

 


            The grand jury charges:

            [Defendant's Name], a resident of [City], [State], conducted a business as a sole proprietorship1 under the name , with its principal place of business in [City], [State]. During the first quarter2 of the year 20__, ending , 20__, he [she] deducted and collected from the total taxable wages of his [her] employees federal income taxes and Federal Insurance Contributions Act taxes in the sum of $ . On or about [Month] [Day], [Year], in the District of ________, he [she] did willfully fail to truthfully account for and pay over to the Internal Revenue Service the federal income taxes and Federal Insurance Contributions Act taxes withheld and due and owing to the United States of America for the quarter ending , 20__.

            In violation of Title 26, United States Code, Section 7202.

                                                                 A True Bill.

 

                                                                                          

                                                                 Foreperson



                             

United States Attorney




[F-32]

NOTES


1 If taxpayer is a corporation, refer to Form 13 as a guide in charging appropriate corporate officials with an offense involving violation of a corporation's obligations under the law.


2 Designate the appropriate quarter.



[F-33]

Form 17


26 U.S.C. § 7202

Failure to Account for and Pay Over

Withholding and F.I.C.A. (Social Security) Taxes

Sole Proprietorship


IN THE DISTRICT COURT OF THE UNITED STATESFOR THE __________ DISTRICT OF __________

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7202
________________________ )  



The grand jury charges:

 

            [Defendant's Name], a resident of [City], [State], conducted a business as a sole proprietorship1 under the name __________, with its principal place of business in [City], [State]. During the _______ quarter2 of the year 20__, ending __________, 20__, [Defendant's Name] deducted and collected from the total taxable wages of his [her] employees federal income taxes and Federal Insurance Contributions Act taxes in the amount of $__________. On or about [Month] [Day], [Year], in the __________ District of __________, [Defendant's Name], did willfully fail to truthfully account for and pay over to the Internal Revenue Service the federal income taxes and Federal Insurance Contributions Act taxes withheld and due and owing to the United States of America for the quarter ending __________, 20__.


In violation of Title 26, United States Code, Section 7202.



                                                                           A True Bill.



                                                                           ____________________

                                                                           Foreperson

_____________________

United States Attorney





[F-34]

NOTES


1 If taxpayer is a corporation, refer to Form 13 as a guide in charging appropriate corporate officials with an offense involving violation of a corporation's obligations under the law.


2 Designate appropriate quarter.


[F-35]

Form 18


26 U.S.C. § 7202

Failure to Pay Over

Withholding and F.I.C.A. (Social Security) Taxes

Sole Proprietorship


IN THE DISTRICT COURT OF THE UNITED STATES FOR THE __________ DISTRICT OF __________

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7202
________________________ )  


The grand jury charges:

 

            [Defendant's Name], a resident of [City], [State], conducted a business as a sole proprietorship1 under the name __________, with its principal place of business in [City], [State]. During the _______ quarter2 of the year 20__, ending __________, 20__, [Defendant's Name] deducted and collected from the total taxable wages of his [her] employees, and truthfully accounted for, federal income taxes and Federal Insurance Contributions Act taxes in the amount of $__________. However, on or about [Month] [Day], [Year], in the __________ District of __________, [Defendant's Name], did willfully fail to pay over to the Internal Revenue Service the federal income taxes withheld and Federal Insurance Contributions Act taxes due and owing to the United States of America for the quarter ending __________, 20__.


In violation of Title 26, United States Code, Section 7202.



                                                                           A True Bill.



                                                                           ____________________

                                                                           Foreperson

_____________________

United States Attorney




[F-36]

NOTES


1 If taxpayer is a corporation, refer to Form 13 as a guide in charging appropriate corporate officials with an offense involving violation of a corporation's obligations under the law.


2 Designate appropriate quarter.


[F-37]

Form 19


26 U.S.C. § 7202

Failure to Truthfully Account for and Pay Over

Withholding and F.I.C.A. (Social Security) Taxes

Corporation


IN THE DISTRICT COURT OF THE UNITED STATES FOR THE __________ DISTRICT OF __________

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7202
________________________ )  


The grand jury charges:


Introductory Allegations

Parties and Entities


            1.       At all times relevant to this indictment, [Business Name] was a corporation doing business in [City], [State], which is within the _______ District of ____. [Business Name] was in the business of [Describe type of business].

            2.       In or about [Month Year], defendant [Name] acquired control of [Business Name]. [Business Name] was purchased by an entity known as “[Nominee],” which also involved other individuals, but it was essentially controlled by defendant [Name].

            3.       Beginning in or about [Month Year], and continuing until on or about [Month Year], defendant [Name] acted as [Business Name]’s general manager. Defendant [Name] exercised control over every aspect of [Business Name]’s business affairs, including approving all payments by the company and controlling all of [Business Name]’s bank accounts.

            4.       During the period [Month Year] through [Month Year], defendant [Name] caused [Business Name] to make thousands of dollars of expenditures for defendant’s personal benefit while, at the same time, failing to pay over to the Internal Revenue Service payroll tax withheld from [Business Name]'s employees’ paychecks and, further, failing to remit monies withheld from [Business Name]'s employees’ paychecks for various employee benefits, including health insurance, dental coverage, and group life insurance. For example, [Name] caused [Business Name] to spend thousands and thousands of dollars for [List items] for [Name] and members of [Name]’s family.


[F-38]

Employment Tax Withholding


            5.       At all times relevant to this Indictment, [Business Name] withheld taxes from its employees’ paychecks, including federal income taxes, medicare and social security taxes (often referred to as Federal Insurance Contribution Act or "FICA" taxes). These taxes will be referred to in this Indictment collectively as "payroll taxes."

            6.       [Business Name] was required to make deposits of the payroll taxes to the Internal Revenue Service on a periodic basis. In addition, [Business Name] was required to file, following the end of each calendar quarter, an Employer’s Quarterly Federal Income Tax Return (Form 941), setting forth the total amount of wages and other compensation subject to withholding, the total amount of income tax withheld, the total amount of social security and Medicare taxes due, and the total tax deposits.

            7.       As general manager of [Business Name], defendant [Name] was a “responsible person,” that is, he had the corporate responsibility to collect, truthfully account for, and pay over [Business Name]’s payroll taxes.

            8.       Throughout the calendar years [Year] and [Year], [Business Name] withheld tax payments from its employees’ paychecks. However, beginning in approximately [Month Year], [Business Name] made no payments to the Internal Revenue Service, which were due [set forth deposit requirement].

            9.       Beginning in [Year], [Business Name] further failed to file quarterly employment tax returns (Forms 941) with the Internal Revenue Service. Each Form 941 was due to be filed at the end of the month following the end of each calendar quarter. For example, the Form 941 for the _____ quarter of [Year] was due on or before [Date], since the ____ calendar quarter ended on [Date].

            10.     Altogether, during the five calendar quarters alleged in Counts 1-5 of this Indictment, [Business Name] failed to account for and pay over approximately $_________ in payroll taxes, as set forth below:

 

            Last Quarter of 1999                    $_________

            First Quarter of 2000                   $_________

            Second Quarter of 2000               $_________

            Third Quarter of 2000                  $_________

            Fourth Quarter of 2000                $_________



[F-39]

Counts 1-5


Failure to Account For and Pay Over Employment Tax


            Beginning on or about [Date], and continuing up to and including on or about [Date], in the ______ District of ______, the defendant, [Name], did willfully fail to truthfully account for and pay over to the Internal Revenue Service all of the federal income taxes withheld and Federal Insurance Contributions Act ("FICA") taxes due and owing to the United States on behalf of [Business Name] and its employees, for each of the following quarters, with each calendar quarter constituting a separate count of this Indictment:

 

            Count 1                   Fourth quarter of 1999

            Count 2                   First quarter of 2000

            Count 3                   Second quarter of 2000

            Count 4                   Third quarter of 2000

            Count 5                   Fourth quarter of 2000


            Each of these counts is a separate violation of Title 26, United States Code, Section 7202.




                                                                           _____________________________

                                                                           Foreperson



            United States Attorney


 

By:      _______________________________

 


[F-40]

Form 20


26 U.S.C. § 7203

Individual Return - Failure to File


IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE ______ DISTRICT OF ______


UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7203
________________________ )  

            The United States Attorney charges:

            During the calendar year1 20__, [Defendant’s Name], who was a resident of [City], [State],2 had and received gross income of $__________.3 By reason of such gross income, he [she] was required by law, following the close of the calendar year1 20__ and on or before April 15, 20__,4 to make an income tax return to the Internal Revenue Service Center, at [City], [State], to a person assigned to receive returns at the local office of the Internal Revenue Service at [City], [State], or to another Internal Revenue Service office permitted by the Commissioner of Internal Revenue, stating specifically the items of his [her] gross income and any deductions and credits to which he [she] was entitled. Well knowing and believing all of the foregoing, he [she] did willfully fail, on or about April 15, 20__,4 in the __________ District of __________ and elsewhere, to make an income tax return.

In violation of Title 26, United States Code, Section 7203.

 

___________________

United States Attorney

 

 



[F-41]

NOTES

 

1 If a fiscal year is involved, substitute “fiscal year ended __________, 20__.” Fiscal year individual returns must be filed on or before the 15th day of the fourth month after the end of the fiscal year. 26 U.S.C. § 6072(a).


2 If venue is based on defendant’s principal place of business, substitute for residence, “whose principal place of business was in [City], [State].”


3 If the amount of gross income is not to be alleged, substitute “had and received gross income in excess of $__________ [minimum filing requirement].” For definition of gross income, see 26 U.S.C. § 61.

 

4 If April 15th fell on a Saturday, Sunday, or legal holiday, the appropriate date in the information would be the next succeeding day that was not a Saturday, Sunday, or legal holiday. Note that taxpayers who file at the Andover Service Center receive an extra day to file in those years when the filing date coincides with Patriots’ Day in Massachusetts, which falls on the third Monday of April. Also note that the date the return was due should include any authorized extensions of time for filing. 26 U.S.C. § 7503.


[F-42]

Form 21


26 U.S.C. § 7203

Individual Return - Failure to File

Filing Requirement Based on Joint Income of Taxpayer and Spouse

where (1) Taxpayer and Spouse were entitled to file a joint return and

2) Had the Same Residence as Their Household at the Close of the Taxable Year


IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE ______ DISTRICT OF ______


UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7203
________________________ )  

 

 

            The United States Attorney charges:

            During the calendar year1 20__, [Defendant’s Name], who was a resident of [City], [State],2 and his [her] spouse had and received gross income totaling $__________.3 By reason of that gross income, he [she] was required by law, following the close of the calendar year 20__ and on or before April 15, 20__,4 to make an income tax return to the Internal Revenue Service Center, at [City], [State], to a person assigned to receive returns at the local office of the Internal Revenue Service at [City], [State], or to another Internal Revenue Service office permitted by the Commissioner of Internal Revenue, stating specifically the items of his [her] gross income and any deductions and credits to which he [she] was entitled. Well knowing and believing all the foregoing, he [she] did willfully fail, on or about April 15, 20__, 4 in the __________ District of __________ and elsewhere, to make an income tax return.

            In violation of Title 26, United States Code, Section 7203.

____________________

United States Attorney

 



[F-43]

NOTES

 

1 If a fiscal year is involved, substitute “fiscal year ended __________, 20__.” Fiscal year individual returns must be filed on or before the 15th day of the fourth month after the end of the fiscal year. 26 U.S.C. § 6072(a).

 

2 If venue is based on the defendant’s principal place of business, substitute for residence, “whose principal place of business was in [City], [State].”

 

3 If the amount of gross income is not to be alleged, substitute “had and received gross income in excess of $__________ [minimum filing requirement].” With respect to the filing requirement for a married individual, 26 U.S.C. 6012(a)(1) provides that “a return shall not be required of an individual . . . (iv) who is entitled to make a joint return and whose gross income, when combined with the gross income of his spouse, is, for the taxable year, less than the sum of twice the exemption amount [see 26 U.S.C. § 151(d)] plus the basic standard deduction applicable to a joint return, but only if such individual and his spouse, at the close of the taxable year, had the same household as their home. Clause (iv) shall not apply if for the taxable year such spouse makes a separate return or any other taxpayer is entitled to an exemption for such spouse under section 151(c).” For the definition of gross income, see 26 U.S.C. § 61.

 

4 If April 15th fell on a Saturday, Sunday, or legal holiday, the appropriate date in the information would be the next succeeding day that was not a Saturday, Sunday, or legal holiday. Note that taxpayers who file at the Andover Service Center receive an extra day to file in those years when the filing date coincides with Patriots’ Day in Massachusetts, which falls on the third Monday of April. Also note that the date the return was due should include any authorized extensions of time for filing. 26 U.S.C. § 7503.


[F-44]

Form 22


26 U.S.C. § 7203

Individual Return - Failure to File Community Property State Alternative


IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE ______ DISTRICT OF ______


UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7203
________________________ )  

 

 

            The United States Attorney charges:

            During the calendar year1 20__, the defendant, [Defendant’s Name], and his [her] spouse, [Spouse’s Name], who were husband and wife and were residents of [City], [State],2 which is a community property state, had and received gross income computed on the community property basis of $_____ and $__________, respectively.3 By reason of such income, the law required the defendant, following the close of the calendar year 20__ and on or before April 15, 20__,4 to make an income tax return to the person assigned to receive returns at the local office of the Internal Revenue Service at [City], [State], or to the Internal Revenue Service Center, at [City], [State], or to another Internal Revenue Service office permitted by the Commissioner of Internal Revenue, stating specifically the items of his [her] gross income and any deductions and credits to which he [she] was entitled. Well knowing and believing all the foregoing, the defendant did willfully fail, on or about April 15, 20__,4 in the __________ District of __________ and elsewhere, to make an income tax return.

            In violation of Title 26, United States Code, Section 7203.

 

____________________

United States Attorney

 



[F-45]

NOTES

 

1 If a fiscal year is involved, substitute “fiscal year ended ________, 20__.” Fiscal year individual returns must be filed on or before the 15th day of the fourth month after the end of the fiscal year. 26 U.S.C. § 6072(a).

 

2 If venue is based on the defendant’s principal place of business, substitute for residence, “whose principal place of business was in [City], [State].”

 

3 If the amount of gross income is not to be alleged, substitute “had and received gross income in excess of $__________ [minimum filing requirement].” With respect to the filing requirement for a married individual, 26 U.S.C. 6012(a)(1) provides that “a return shall not be required of an individual . . . (iv) who is entitled to make a joint return and whose gross income, when combined with the gross income of his spouse, is, for the taxable year, less than the sum of twice the exemption amount [see 26 U.S.C. § 151(d)] plus the basic standard deduction applicable to a joint return, but only if such individual and his spouse, at the close of the taxable year, had the same household as their home. Clause (iv) shall not apply if for the taxable year such spouse makes a separate return or any other taxpayer is entitled to an exemption for such spouse under section 151(c).” For spouses residing in a community property state, each spouse’s gross income is computed on the community property basis. For definition of gross income, see 26 U.S.C. § 61.

 

4 If April 15th fell on a Saturday, Sunday, or legal holiday, the appropriate date in the information would be the next succeeding day that was not a Saturday, Sunday, or legal holiday. Note that taxpayers who file at the Andover Service Center receive an extra day to file in those years when the filing date coincides with Patriots’ Day in Massachusetts, which falls on the third Monday of April. Also note that the date the return was due should include any authorized extensions of time for filing. 26 U.S.C. § 7503.

 


[F-46]

Form 23


            26 U.S.C. § 7203

Partnership Return - Failure to File


IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE ______ DISTRICT OF ______


UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7203
________________________ )  

 

 

            The United States Attorney charges:

            During the calendar year1 20__, [Defendant’s Name] conducted a business as a partnership under the name of __________, with its principal place of business at [City], [State]. He [she] therefore was required by law, following the close of the calendar year1 20__ and on or before April 15, 20__,2 to make, for and on behalf of the partnership, a partnership return of income to the Internal Revenue Service Center, at [City], [State], stating specifically the items of the partnership’s gross income and the deductions and credits allowed by law. Well knowing and believing all of the foregoing, he [she] did willfully fail, on or about April 15, 20__, in the __________ District of __________ and elsewhere, to make a partnership return.

In violation of Title 26, United States Code, Section 7203.

 

____________________

United States Attorney




[F-47]

NOTES


1 If a fiscal year is involved, substitute “fiscal year ended __________, 20__”.

 

2 Fiscal year partnership returns must be filed on or before the 15th day of the fourth month following the close of the fiscal year. 26 U.S.C. §§ 6031, 6072(a). Note that if the fifteenth day fell on a Saturday, Sunday, or legal holiday, the appropriate date in the information would be the next succeeding day that was not a Saturday, Sunday, or legal holiday. Note that taxpayers who file at the Andover Service Center receive an extra day to file in those years when the filing date coincides with Patriots’ Day in Massachusetts, which falls on the third Monday of April. Also note that the date the return was due should include any authorized extensions of time for filing. 26 U.S.C. § 7503.


[F-48]

Form 24

26 U.S.C. § 7203

Corporation Return - Failure to File


IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE ______ DISTRICT OF ______


UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7203
________________________ )  

 

 

            The United States Attorney charges:

            During the calendar year1 20__, the defendant, [Defendant’s Name],2 was the [Position Held in Corporation] of [Name of Corporation], a corporation not expressly exempt from tax, with its principal place of business at [City], [State]. He [she] [it] therefore was required by law, after the close of the calendar year1 20__ and on or before March 15, 20__,3 to make an income tax return, for and on behalf of the corporation, to the Internal Revenue Service Center, at [City], [State], or to the person assigned to receive returns at the local office of the Internal Revenue Service at [City], [State], stating specifically the items of the corporation’s gross income and the deductions and credits allowed by law. Well knowing and believing all of the foregoing, he [she] [it] did willfully fail, on or about March 15, 20__,3 in the __________ District of __________ and elsewhere, to make an income tax return at the time required by law.

In violation of Title 26, United States Code, Section 7203.


____________________

 United States Attorney




[F-49]

NOTES

 

1 If a fiscal year is involved, substitute “fiscal year ended __________, 20__.”

2 If the corporation is named as the defendant, substitute the name of the corporation.

3 Fiscal year corporation income tax returns must be filed on or before the 15th day of the third month following the close of the fiscal year. 26 U.S.C. § 6072(b). Note that if the fifteenth day fell on a Saturday, Sunday, or legal holiday, the appropriate date in the information would be the next succeeding day that was not a Saturday, Sunday, or legal holiday. Note that taxpayers who file at the Andover Service Center receive an extra day to file in those years when the filing date coincides with Patriots’ Day in Massachusetts, which falls on the third Monday of April. Also note that the date the return was due should include any authorized extensions of time for filing. 26 U.S.C. § 7503.


[F-50]

Form 25


26 U.S.C. § 7203

Failure to File

Individual - Information Return


IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE ______ DISTRICT OF ______


UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7203
________________________ )  

 


            The United States Attorney charges:

            During the calendar year 20__, the defendant, [Defendant’s Name], made payments of [e.g., Rent, Salaries, Wages, Premiums, Annuities, Compensations, Remunerations, Gains, Profits, or Income] to the persons and in the amounts following:

NAME

ADDRESS

AMOUNT

__________

__________

__________

__________

__________

__________

__________

__________

__________


By reason of those payments, [Defendant’s Name] was required by law to make, to the Internal Revenue Service, at [City], [State],2 on or before February 28, 20__,1 a return on United States Treasury Department Internal Revenue Service Form(s) 1099, setting forth the information shown in the table above, and on United States Treasury Department Internal Revenue Service Form 1096, setting forth, among other things, the total amount of payments and the number of accompanying Form(s) 1099. Well knowing all of the foregoing, [Defendant’s Name] did willfully fail, on or about February 28, 20__,1 in the ___________ District of ____________ to make such a return.

 


            In violation of Title 26, United States Code, Section 7203.

 

____________________

 United States Attorney

 


[F-51]

NOTES


1 Returns made under section 6041 on Forms 1096 and 1099 for any calendar year shall be filed on or before February 28 (March 31 if filed electronically) of the following year with any of the Internal Revenue Service Centers, the addresses of which are listed in the instructions for such forms.


2 Use Internal Revenue Service Center where Form 1096 was required to be filed. See Instructions for Forms 1096; Treas. Reg. 1.6041-6 (26 C.F.R.).


[F-52]

Form 26


26 U.S.C. § 7203

Failure to File

Individual - 26 U.S.C. § 6050I

Returns Relating to Cash Received in Trade or Business

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE ______ DISTRICT OF ______


UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7203
________________________ )  

 


            The grand jury charges:

            During the calendar year 20__, in the [Judicial District], the defendant [Defendant’s Name], was the [Position Held in Business] of a business located in [City], [State], under the name of [Name of Business], and was engaged in trade and business as [Type of Business].

            On or about [Date of Cash Transaction], defendant [Defendant’s Name], in connection with a transaction relating to [Trade or Business - Insert Description of Transaction (e.g., the sale of an automobile to an undercover agent of the Internal Revenue Service)], did receive [Amount involved in cash transaction] in cash from [Name of Person Conducting Transaction] as [Reason for Receipt (e.g., payment for automobile)].1

            By virtue of his receipt of [Amount of Cash] on [Date of Cash Transaction], defendant [Defendant’s Name] was required by law, pursuant to Title 26, United States Code, Section 6050I, and Treas. Reg. §1.6050I-1 (26 C.F.R.), to file with the Internal Revenue Service office specified by the Secretary of the Treasury, at [City], [State], in the __________ District of __________, within 15 days of his [her] receipt of the [Amount of Cash], a return on IRS Form 8300 in the manner and form stated thereon, stating, among other things, the name, address, and taxpayer identification number of the person from whom he [she] received the cash; the amount of cash received; and the date and nature of the transaction.

            Well knowing all of the foregoing facts, defendant [Defendant’s Name] did willfully fail to file the required return with the Internal Revenue Service.

In violation of Title 26, United States Code, Section 7203.

A True Bill.


 ____________________

 Foreperson


____________________

United States Attorney



[F-53]

NOTES


1 Treasury Regulation 1.6050I-1 (26 C.F.R.) provides as follows for multiple payments or installment payments:

            (b) Multiple payments. The receipt of multiple cash deposits or cash installment payments (or other similar payments or prepayments) on or after January 1, 1990, relating to a single transaction (or two or more related transactions), is reported as set forth in paragraphs (b)(1) through (b)(3) of this section.

            (1) Initial payment in excess of $10,000. If the initial payment exceeds $10,000, the recipient must report the initial payment within 15 days of its receipt.

            (2) Initial payment of $10,000 or less. If the initial payment does not exceed $10,000, the recipient must aggregate the initial payment and subsequent payments made within one year of the initial payment until the aggregate amount exceeds $10,000, and report with respect to the aggregate amount within 15 days after receiving the payment that causes the aggregate amount to exceed $10,000.

            (3) Subsequent payments. In addition to any other required report, a report must be made each time that previously unreportable payments made within a 12-month period with respect to a single transaction (or two or more related transactions), individually or in the aggregate, exceed $10,000. The report must be made within 15 days after receiving the payment in excess of $10,000 or the payment that causes the aggregate amount received in the 12- month period to exceed $10,000. (If more than one report would otherwise be required for multiple cash payments within a 15-day period that relate to a single transaction (or two or more related transactions), the recipient may make a single combined report with respect to the payments. The combined report must be made no later than the date by which the first of the separate reports would otherwise be required to be made.) A report with respect to payments of $10,000 or less that are reportable under this paragraph (b)(3) and are received after December 31, 1989, but before July 10, 1990, is due July 24, 1990.


[F-54]

Form 27


26 U.S.C. § 7203

Failure to File

Individual - 26 U.S.C. § 6050I

Returns Relating to Cash Received in Trade or Business


IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE ______ DISTRICT OF ______


UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7203
________________________ )  

            

            The grand jury charges:

            On or about [Month] [Day], [Year], in the __________ District of __________, [Defendant’s Name], whose principal place of business was in [City], [State], received a payment in a trade or business, to wit, [identify trade or business], in excess of $10,000 United States currency, to wit, [amount of currency].1 [Defendant’s Name] therefore was required by law to make a return on United States Treasury Department Internal Revenue Service Form 8300 on or before [Month] [Day], [Year], to the Internal Revenue Service office specified by the Secretary of the Treasury, at [City], [State], in the __________ District of __________, stating specifically the identity of the individual from whom the cash was received, the person on whose behalf the transaction was conducted, the description of the transaction and method of payment, and the business that received the cash. Well knowing and believing all of the foregoing, [Defendant’s Name] did willfully fail to make such a return to an office of the Internal Revenue Service at the required time and place.

            In violation of Title 26, United States Code, Sections 6050I and 7203, and § 1.6050I-1 (26 C.F.R.).


A True Bill.


____________________

 Foreperson


____________________

United States Attorney

 


[F-55]

NOTES


1 Treasury Regulation 1.6050I-1 (26 C.F.R.) provides as follows for multiple payments or installment payments:

            (b) Multiple payments. The receipt of multiple cash deposits or cash installment payments (or other similar payments or prepayments) on or after January 1, 1990, relating to a single transaction (or two or more related transactions), is reported as set forth in paragraphs (b)(1) through (b)(3) of this section.

            (1) Initial payment in excess of $10,000. If the initial payment exceeds $10,000, the recipient must report the initial payment within 15 days of its receipt.

            (2) Initial payment of $10,000 or less. If the initial payment does not exceed $10,000, the recipient must aggregate the initial payment and subsequent payments made within one year of the initial payment until the aggregate amount exceeds $10,000, and report with respect to the aggregate amount within 15 days after receiving the payment that causes the aggregate amount to exceed $10,000.

            (3) Subsequent payments. In addition to any other required report, a report must be made each time that previously unreportable payments made within a 12-month period with respect to a single transaction (or two or more related transactions), individually or in the aggregate, exceed $10,000. The report must be made within 15 days after receiving the payment in excess of $10,000 or the payment that causes the aggregate amount received in the 12- month period to exceed $10,000. (If more than one report would otherwise be required for multiple cash payments within a 15-day period that relate to a single transaction (or two or more related transactions), the recipient may make a single combined report with respect to the payments. The combined report must be made no later than the date by which the first of the separate reports would otherwise be required to be made.) A report with respect to payments of $10,000 or less that are reportable under this paragraph (b)(3) and are received after December 31, 1989, but before July 10, 1990, is due July 24, 1990.


[F-56]

Form 28


26 U.S.C. § 7203

Individual - Failure to Pay Tax


IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE ______ DISTRICT OF ______


UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7203
________________________ )  

 


            The United States Attorney charges:

            During the calendar year1 20__, [Defendant’s Name], who was a resident of [City], [State], had and received taxable income of $__________, on which taxable income there was owing to the United States of America an income tax of $__________. He [she] was required by law to pay, on or before April 15, 20__,2 that income tax to the Internal Revenue Service Center, at [City], [State], to a person assigned to receive returns at the local office of the Internal Revenue Service at [City], [State], or to another Internal Revenue Service office permitted by the Commissioner of Internal Revenue. Well knowing all of the foregoing, he [she] did willfully fail, on April 15, 20__2, in the __________ District of __________ and elsewhere, to pay the income tax due.

            In violation of Title 26, United States Code, Section 7203.

 

____________________

United States Attorney

 



[F-57]

NOTES

1 If a fiscal year is involved, substitute “fiscal year ended __________, 20__.” Fiscal year individual returns must be filed on or before the 15th day of the fourth month after the end of the fiscal year. 26 U.S.C. § 6072(a).

2 If April 15th fell on a Saturday, Sunday, or legal holiday, the appropriate date in the information would be the next succeeding day that was not a Saturday, Sunday, or legal holiday. 26 U.S.C. § 7503. Note that taxpayers who file at the Andover Service Center receive an extra day to file in those years when the filing date coincides with Patriots’ Day in Massachusetts, which falls on the third Monday of April. Also note that fiscal year individual returns must be filed on or before the 15th day of the fourth month after the end of the fiscal year. 26 U.S.C.
§ 6072(a).


[F-58]

Form 29


26 U.S.C. § 7203

Failure to File-- Sole Proprietorship or Partnership Employer’s Quarterly Return

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE ______ DISTRICT OF ______

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7203
________________________ )  


            The United States Attorney charges:

            During the period from [Date] to [Date], inclusive, [Defendant’s Name], a resident of [City], [State], was an employer of labor1 and a person required under the provisions of the Internal Revenue Code to make a return of federal income taxes withheld from wages and Federal Insurance Contributions Act (F.I.C.A.) taxes. During that period, he [she] paid wages to his [her] employees which were subject to withholding of federal income taxes and Federal Insurance Contributions Act taxes in the sum of $__________ and $__________, respectively. He [she] therefore was required by law, after [Last Day of Period], and on or before [Return Due Date],2 to make an Employer’s Quarterly Federal Tax Return, Form 941, to the Internal Revenue Service Center, at [City], [State], to a person assigned to receive returns at the local office of the Internal Revenue Service at [City], [State], or to another Internal Revenue Service office permitted by the Commissioner of Internal Revenue. Well knowing and believing all of the foregoing, he [she] did willfully fail, in the __________ District of __________ and elsewhere, to make such a return at the time required by law.

            In violation of Title 26, United States Code, Section 7203.

 

___________________

United States Attorney

 



[F-59]

NOTES

1 If employer is a corporation, refer to Form 13 as a guide in charging appropriate corporate officials with an offense involving violation of a corporation’s obligations under the law.

2 Forms 941 are due on the last day of the month that follows the end of the quarter.


 [F-60]


Form 30

 

26 U.S.C. § 7203

Sole Proprietorship or Partnership Employer’s Quarterly Return

Failure to File - Tabular Form Information

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE ______ DISTRICT OF ______

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7203
________________________ )  

 

 

            The United States Attorney charges:

            1. During the period from [Date] to [Date], inclusive, [Defendant’s Name], a resident of [City], [State], was an employer of labor1 and a person required under the provisions of the Internal Revenue Code to make a return of federal income taxes withheld from wages and Federal Insurance Contributions Act (F.I.C.A.) taxes. During that period he [she] paid to his [her] employees wages which were subject to withholding of federal income taxes and Federal Insurance Contributions Act taxes. He [she] therefore was required by law, after the close of each calendar quarter and on or before each due date,2 to make an Employer’s Quarterly Federal Tax Return, Form 941, to the Internal Revenue Service Center, at [City], [State], to the person assigned to receive returns at the local office of the Internal Revenue Service at [City], [State], or to another Internal Revenue Service office permitted by the Commissioner of Internal Revenue. Well knowing and believing all of the foregoing, he [she] did willfully fail, in the __________ District of __________ and elsewhere, to make, at the time required by law, an Employer’s Quarterly Federal Tax Return, Form 941, for each of the calendar quarters hereinafter set forth during the period from [Date] to [Date].

            2. The allegations of paragraph “1.” herein are repeated and realleged for Counts I through __________, inclusive, of this Information, as though fully set forth therein:

COUNT

QUARTER ENDED

DUE DATE

TOTAL WAGES

FICA TAXES (EMPLOYER’S & EMPLOYEES’)

INCOME TAXES WITHHELD

TOTAL (FICA AND INCOME TAX LIABILITY

I.

_________

_____

______

______________

__________

_____________

II.

_________

_____

______

______________

__________

_____________

III.

_________

_____

______

______________

__________

_____________


[F-61]

            In violation of Title 26, United States Code, Section 7203.

 

____________________

United States Attorney

 

NOTES

1 If the employer is a corporation, refer to Form 13 as a guide in charging appropriate corporate officials with an offense involving violation of a corporation’s obligations under the law.

2 Forms 941 are due on the last day of the month that follows the end of the quarter.


[F-62]

Form 31

 

26 U.S.C. § 7203

Sole Proprietorship or Partnership Excise Tax Return -

Failure to File

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE ______ DISTRICT OF ______

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7203
________________________ )  

 

 

            The United States Attorney charges:

            During the period from [Date] to [Date], [Defendant’s Name]1 conducted a business as a [Sole Proprietorship or Partnership] under the name of __________, with its principal place of business in [City], [State], and sold at retail2 [Article], upon which sales there were due and owing to the United States of America retail dealer’s3 excise taxes in the amount of $__________. He [she] therefore was required by law, after [Last Day Of Period], and on or before [Return Due Date], to make a Quarterly Federal Excise Tax Return4 to the Internal Revenue Service Center, at [City], [State], to the person assigned to receive returns at the local office of the Internal Revenue Service at [City], [State], or to another Internal Revenue Service office permitted by the Commissioner of Internal Revenue. Well knowing and believing all of the foregoing, he [she] did willfully fail, in the __________ District of __________ and elsewhere, to make a Quarterly Federal Excise Tax Return at the time required by law.

            In violation of Title 26, United States Code, Section 7203.

 

____________________

United States Attorney

 



[F-63]

NOTES

1 If the defendant is a corporation, refer to Form 13 as a guide in charging appropriate corporate officials with an offense involving violation of a corporation’s obligations under the law.

2 Designate appropriate business, e.g., manufacturing.

3 For other excise taxes, see 26 U.S.C. § 4041, et seq.

4 Designate appropriate IRS form.


[F-64]


Form 32

 

26 U.S.C. § 7204

Failure to Furnish Employee's Withholding Statement, Form W-2

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7204
________________________ )  

 

 

            The United States Attorney charges:

            During the calendar year 20__, [Defendant's Name],1 a resident of [City], [State], employed [Name of Employee], a resident of [City], [State]. [Defendant's Name] was required under the Internal Revenue laws to deduct and withhold federal income taxes and Federal Insurance Contributions Act taxes with respect to the wages of [Name of Employee] and to furnish him [her] on or before January 31, 20__, with a written statement showing the amount of wages paid and taxes deducted and withheld during the calendar year 20__. On or about the day of , 20__, in the District of ________, [Defendant's Name] did willfully fail to furnish the required statement to the employee, [Name of Employee], in the manner and at the time required by law.

            In violation of Title 26, United States Code, Section 7204.

                                                                                              

                                                                 United States Attorney

 

 

NOTES

 

1 If the employer is a corporation, refer to language in Form 13 as a guide in charging appropriate corporate officials with an offense involving violation of a corporation's obligations under the law.


[F-65]

Form 33

 

26 U.S.C. § 7204

Furnishing False and Fraudulent

Employee's Withholding Statement, Form W-2

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7204
________________________ )  

 

 

            The United States Attorney charges:

            During the calendar year 20__, [Defendant's Name],1 a resident of [City], [State], employed [Name of Employee], a resident of [City], [State]. [Defendant's Name] was required under the Internal Revenue laws to deduct and withhold federal income taxes and Federal Insurance Contributions Act taxes with respect to the wages of [Name of Employee] and to furnish him [her] on or before January 31, 20__, with a written statement showing the amount of wages paid and taxes deducted and withheld during the calendar year 20__. On or about [Month] [Day], [Year], in the District of ________, [Defendant's Name] did willfully furnish to [Name of Employee] a false and fraudulent statement, showing that the total wages paid were $ , that the income taxes deducted and withheld were $ , and that the Federal Insurance Contributions Act taxes deducted and withheld were $_______, whereas, as [Defendant's Name] then and there knew, the total wages paid were $ , the income taxes deducted and withheld were $ , and the Federal Insurance Contributions Act taxes deducted and withheld were $ .

            In violation of Title 26, United States Code, Section 7204.

                                                                                          

                                                                 United States Attorney

 

NOTES

1 If the employer is a corporation, refer to language in Form 13 as a guide in charging appropriate corporate officers with an offense involving violation of a corporation's obligations under the law.


[F-66]

Form 34

 

26 U.S.C. § 7205

False Withholding Allowance Certificate, Form W-4

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7205
________________________ )  

 

 

            The United States Attorney charges:

            During the calendar year 20__, [Defendant's Name], a resident of [City], [State], was employed by [Name of Employer], a resident of [City], [State]. [Defendant's Name] was required under the Internal Revenue laws to furnish [Name of Employer], on or about the date of the commencement of employment by [Name of Employer], with a signed Employee's Withholding Allowance Certificate, Form W-4, setting forth the number of withholding allowances claimed. On or about [Month] [Day], [Year], in the District of ________, [Defendant's Name] did willfully supply a false and fraudulent Employee's Withholding Allowance Certificate, Form W-4, to [Name of Employer], on which [Defendant's Name] claimed withholding allowances,1 whereas, as [Defendant's Name] then and there knew, he [she] was entitled to claim only withholding allowances.2

            In violation of Title 26, United States Code, Section 7205.

                                                                                              

                                                                 United States Attorney

 

 

COMMENTS

 

1 The Government does not have to prove the number of allowances that the defendant could claim. See United States v. McDonough, 603 F.2d 19, 23-24 (7th Cir. 1979).

 

2 The Fifth Circuit has ruled that "withholding exemptions" and "withholding allowances" are the same in the context of the sufficiency of a Section 7205 indictment. United States v. Anderson, 577 F.2d 258, 261 (5th Cir. 1978).



[F-67]

NOTES

 

1 Where appropriate, the following language should be substituted: "he [she] claimed exemption from withholding."

 

2 Where appropriate, the following language should be substituted: "he [she] was not exempt from withholding."


[F-68]

Form 35

 

26 U.S.C. § 7206(1)

Making and Subscribing a False

Return, Statement, or Other Document

Venue in District of Filing

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7206(1)
________________________ )  

 

 

 

            The grand jury charges:

            That on or about [Month] [Day], [Year], in the District of ________, [Defendant's Name], a resident of [City], [State], did willfully make and subscribe1 a [Describe Document], which was verified by a written declaration that it was made under the penalties of perjury and which [Defendant's Name] did not believe to be true and correct as to every material matter. That [Describe Document], which was filed with the Director, Internal Revenue Service Center, at [City], [State],2 stated [Describe the False Fact(s)], whereas, as he [she] then and there knew [Describe Correct Fact(s)].

             In violation of Title 26, United States Code, Section 7206(1).

                                                                 A True Bill.

                                                                                          

                                                                 Foreperson

 

                            

United States Attorney

 



[F-69]

COMMENT

 

1 The Seventh Circuit has approved this type of form as sufficiently charging a § 7206(1) offense. United States v. Marrinson, 832 F.2d 1465, 1476 (7th Cir. 1987).

 

2 It is the Tax Division’s view that no additional allegations are required for an electronically filed return. Internal Revenue Code (26 U.S.C.) Section 6061(b)(1) provides that the Secretary of the Treasury “shall develop procedures for the acceptance of signatures in digital or other electronic form” and that “until such time as such procedures are in place, the Secretary may . . . (B) provide for alternative methods of signing or subscribing, a particular type or class of return, declaration, statement, or other document required or permitted to be made or written under internal revenue laws or regulations.” Subsection (b)(2) of the statute further provides that “[n]otwithstanding any other provision of law, any return, declaration, statement, or other document filed and verified, signed, or subscribed under any method adopted under paragraph (1)(B) shall be treated for all purposes (both civil and criminal, including penalties for perjury) in the same manner as though signed or subscribed.”

 

NOTES

 

1 An aider and abettor may be jointly charged with the principal under 18 U.S.C. § 2. If this is done, the language "and did willfully aid, abet, assist, and cause to be so made and subscribed" should be inserted after the word "subscribe", and an appropriate reference should be made to 18 U.S.C. § 2 as well as 26 U.S.C. § 7206(1). In a case involving joint conduct, the prosecutor should consider charging a violation of 26 U.S.C. 7206(2) instead of § 7206(1).

 

2 If the Service Center was not the place of filing, substitute "with a person assigned to receive returns at the local office of the Internal Revenue Service at [City], [State]" or "with a proper officer of the United States".


[F-70]

Form 36

 

26 U.S.C. § 7206(1)

Making and Subscribing a False

Return, Statement, or Other Document

Venue in District of Preparation and Signing

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7206(1)
________________________ )  

 

 

            The grand jury charges:

            That on or about [Month] [Day], [Year], in the              District of ________, [Defendant's Name], a resident of [City], [State], did willfully make and subscribe1 a [Describe Document], which was verified by a written declaration that it was made under the penalties of perjury and which he [she] did not believe to be true and correct as to every material matter. That [Describe Document], which was prepared and signed in the _______ District of __________ and was filed with the Internal Revenue Service, stated that [Describe the False Fact(s)], whereas, as he [she] then and there knew and believed, [Describe Correct Fact(s)].

            In violation of Title 26, United States Code, Section 7206(1).

                                                                 A True Bill.

                                                                                          

                                                                 Foreperson

 

                            

United States Attorney

 

 



[F-71]

COMMENT

 

1 The Seventh Circuit has approved this type of form as sufficiently charging a § 7206(1) offense. United States v. Marrinson, 832 F.2d 1465, 1476 (7th Cir. 1987).

 

NOTES

1 An aider and abettor may be jointly charged with the principal under 18 U.S.C. § 2. If this is done, the language "and did willfully aid, abet, assist, and cause to be so made and subscribed" should be inserted after the word "subscribe" and appropriate reference should be made to 18 U.S.C. § 2, as well as 26 U.S.C. § 7206(1). In a case involving joint conduct, the prosecutor should consider charging a violation of 26 U.S.C. 7206(2) instead of § 7206(1).


[F-72]

Form 37

 

26 U.S.C. § 7206(1)

Making and Subscribing a False Return

False Amount Not Specified - Open Ended Indictment

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7206(1)
________________________ )  

 

 

 

            The grand jury charges:

            That on or about [Month] [Day], [Year], in the District of                   , [Defendant's Name], a resident of [City], [State], did willfully make and subscribe1 a [joint] U.S. Individual Income Tax Return,2 for the calendar year3 20__, which was verified by a written declaration that it was made under the penalties of perjury and which he [she] did not believe to be true and correct as to every material matter. That income tax return, which was filed with the Internal Revenue Service,4 reported [State Each False Item of Income Reported, e.g., Dividend Income in the Amount of $ , Interest Income in the Amount of $ ,], whereas, as he [she] then and there well knew and believed, he [she] received [State Each False Item But Not Amount, e.g., Interest Income and Dividend Income] in addition to the amount stated in the return.

            In violation of Title 26, United States Code, Section 7206(1).

                                                                 A True Bill.

 

                                                                                          

                                                                 Foreperson

 

                            

United States Attorney

 

 



[F-73]

NOTES

 

1 An aider and abettor may be jointly charged with the principal under 18 U.S.C. § 2. If this is done, the language "and did willfully aid, abet, assist, and cause to be so made and subscribed" should be inserted after the word "subscribe", and appropriate reference should be made to 18 U.S.C. § 2 as well as 26 U.S.C. § 7206(1). In a case involving joint conduct, the prosecutor should consider charging a violation of 26 U.S.C. 7206(2) instead of section 7206(1).

 

2 Where appropriate, substitute correct tax return, e.g., U.S. Corporation Income Tax Return.

 

3 If a fiscal year is involved, substitute "fiscal year ended , 20__". Fiscal year individual returns must be filed on or before the 15th day of the fourth month after the end of the fiscal year. 26 U.S.C. § 6072(a).

 

4 If venue is to be placed in the district of filing, modify this form in accordance with language in Form 35.


[F-74]

Form 38

 

26 U.S.C. § 7206(1)

Making and Subscribing a False Return

Failure to Disclose a Business

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7206(1)
________________________ )  

 

 

 

            The grand jury charges:

            That on or about [Month] [Day], [Year], in the District of                , [Defendant's Name], a resident of [City], [State], did willfully make and subscribe a [joint] U.S. Individual Income Tax Return, for the calendar year 20__,1 which was verified by a written declaration that it was made under the penalties of perjury. [Defendant's Name] did not believe the return, which was filed with the Internal Revenue Service,2 to be true and correct as to every material matter in that the return failed to disclose that he [she] was engaged in the operation of a business activity from which he [she] derived gross receipts or sales and received income. [Defendant's Name] then and there well knew and believed that he [she] was required by law and regulation to disclose the operation of this business activity, the gross receipts or sales he [she] derived therefrom, and the income from the business activity.

            In violation of Title 26, United States Code, Section 7206(1).

                                                                 A True Bill.

 

                                                                                          

                                                                 Foreperson

 

                                     

United States Attorney

 

 



[F-75]

NOTES

 

1 If fiscal year is involved, substitute "fiscal year ended , 20__". Fiscal year individual returns must be filed on or before the 15th day of the fourth month after the end of the fiscal year. 26 U.S.C. § 6072(a).

 

2 If venue is to be placed in the district of filing, modify this form in accordance with language in Form 35.


[F-76]

Form 39

 

26 U.S.C. § 7206(1)

Individual - 26 U.S.C. 6050I

Returns Relating to Cash Received in Trade or Business

Filing False Return

 

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No.
  ) 26 U.S.C. § 7206(1)
________________________ )  

 

 

            The grand jury charges:

            That on or about [Month] [Day], [Year], in the District of                      , [Defendant's Name], a resident of [City], [State], did willfully make and subscribe a return on United States Treasury Department Internal Revenue Service Form 8300, for a cash payment in excess of $10,000 received on [Date], which was verified by a written declaration that it was made under the penalties of perjury. [Defendant's Name] did not believe that the return on United States Treasury Department Internal Revenue Service Form 8300, which was filed with the Internal Revenue Service, was true and correct as to every material matter in that the return reported [State Each False Item Reported, e.g., Name of Payor, Cash Received in the Amount of $ ]. In fact, as he [she] then and there well knew and believed, he [she] received [State Each False Item But Not Amount, e.g., Name of Payor, Cash Received in Excess of Amount Reported], in addition to that stated on the Form 8300.

            In violation of Title 26, United States Code, Sections 6050I and 7206(1), and 26 Code of Federal Regulations, Section 1.6050I-1.

                                                                 A True Bill.

                                                                                          

                                                                 Foreperson

 

                                     

United States Attorney


[F-77]

Form 40

 

26 U.S.C. § 7206(2)

Aiding and Assisting in the Preparation and Presentation

of a False and Fraudulent Return, Statement, or Other Document

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7206(2)
________________________ )  

 

 

 

            The grand jury charges:

            That on or about [Month] [Day], [Year], in the District of                , the defendant, [Defendant's Name], a resident of [City], [State], did willfully aid and assist in, and procure, counsel, and advise the preparation and presentation to the Internal Revenue Service, of a U.S. Individual Income Tax Return, Form 1040,1 of [Taxpayer's Name] for the calendar year2 20__. The return was false and fraudulent as to a material matter, in that [Describe False Fact(s), e.g., it represented that [Taxpayer's Name] was entitled under the provisions of the Internal Revenue laws to claim deductions in the total sum of $ ], whereas, as the defendant then and there knew, [Describe Correct Fact(s), e.g., the total deductions [Taxpayer's Name] was entitled to claim for the calendar year were in the total sum of $ ].

            In violation of Title 26, United States Code, Section 7206(2).

                                                                 A True Bill.

 

                                                                                          

                                                                 Foreperson

 

                            

United States Attorney

 



[F-78]

NOTES

 

1 Designate appropriate document if not a tax return, e.g., a financial statement.

 

2 If fiscal year is involved, substitute "fiscal year ended , 20__". Fiscal year individual returns must be filed on or before the 15th day of the fourth month after the end of the fiscal year. 26 U.S.C. § 6072(a).


[F-79]

Form 41

 

26 U.S.C. § 7206(2)

Aiding and Assisting in the Preparation and Presentation

of False and Fraudulent Individual Income Tax Returns

Containing False Deductions - Tabular Form Indictment

 

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7206(2)
________________________ )  

 

 

            The grand jury charges:

            1.       That on or about the dates hereinafter set forth, in the District of ________, the defendant, [Defendant's Name], a resident of [City], [State], did willfully aid and assist in, and procure, counsel, and advise the preparation and presentation to the Internal Revenue Service, of U.S. Individual Income Tax Returns, Forms 1040, either individual or joint, for the taxpayers and calendar years hereinafter specified. The returns were false and fraudulent as to material matters, in that they represented that the taxpayers were entitled under the provisions of the Internal Revenue laws to claim deductions for items and in amounts hereinafter specified, whereas, as the defendant then and there knew, the taxpayers were not entitled to claim deductions in the claimed amounts.

            2.       The allegations of paragraph "1." are repeated and realleged in Counts I through

      , inclusive, of this Indictment, as though fully set forth therein:

 

COUNT

DATE OF

OFFENSE

TAXPAYER

CALENDAR

TAX YEAR

FALSELY

CLAIMED

ITEM1

AMOUNT

CLAIMED

I.

 

 

 

 

 

II.

 

 

 

 

 

III.

 

 

 

 

 


[F-80]


          In violation of Title 26, United States Code, Section 7206(2).

 

                                                                 A True Bill.

 

                                                                                          

                                                                 Foreperson

 

                                     

United States Attorney

 

NOTES

 

1 Where the fraudulent deductions (generally itemized deductions) consist of alleged payments to individuals or organizations, list each fraudulent payment, rather than totalling such payments in the deduction category under which they were claimed on the return. For example, list "Medical Expenses Dr. Jones-$500; Dr. Smith-$500," not, "Medical Expenses $1,000." This will prevent a defense that additional, unclaimed deductions in the same deduction category are available to offset the false items.


[F-81]

Form 42

 

26 U.S.C. § 7206(4)

Removal or Concealment of Goods or Commodities

With Intent to Evade or Defeat

The Assessment or Collection of a Tax

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7206(4)
________________________ )  

 

 

            The grand jury charges:

            That on or about [Month] [Day], [Year], in the District of             , [Defendant's Name], a resident of [City], [State], with intent to evade and defeat the collection of income taxes assessed against him [her] on or about , 20__, by the Internal Revenue Service,1 did knowingly and unlawfully remove and conceal [Describe Property], upon which levy was authorized by Section 6331 of the Internal Revenue Code.

            In violation of Title 26, United States Code, Section 7206(4).

                                                                 A True Bill.

 

                                                                                          

                                                                 Foreperson

                                     

United States Attorney

 

NOTES

 

1 Where appropriate, substitute "evade and defeat the assessment of income taxes against him [her] by the Internal Revenue Service."

 


[F-82]

Form 43

 

26 U.S.C. § 7206(5)(A)

Concealment of Assets in Connection

with a Compromise or Closing Agreement

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF

 

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7206(5)(A)
________________________ )  

 

 

 

            The grand jury charges:

            That on or about [Month] [Day], [Year], in the District of             , [Defendant's Name], a resident of [City], [State], in connection with an offer in compromise1 relating to his [her] liability for [Type of Tax] taxes due and owing by him [her] to the United States of America for the calendar year(s) ,2 did willfully conceal from [Specify Particular Officer, with Job Title] and all other proper officers and employees of the United States, [Describe Property Belonging to Taxpayer or Other Person Liable for the Tax].

            In violation of Title 26, United States Code, Section 7206(5)(A).

                                                                 A True Bill.

                                                                                          

                                                                 Foreperson

 

                            

United States Attorney

 

NOTES

 

1 Where appropriate, substitute "a compromise"; or "a closing agreement"; or "an offer to enter into a closing agreement".

 

2 If fiscal year is involved, substitute "fiscal year(s) ended , 20__". Fiscal year individual returns must be filed on or before the 15th day of the fourth month after the end of the fiscal year. 26 U.S.C. § 6072(a).


[F-83]


Form 44

 

26 U.S.C. § 7206(5)(B)

Withholding, Falsifying, or Destroying Records

or Making a False Statement in Connection with

a Compromise or Closing Agreement

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7206(5)(B)
________________________ )  

 

 

            The grand jury charges:

            That on or about [Month] [Day], [Year], in the District of             , [Defendant's Name], a resident of [City], [State], in connection with an offer in compromise1 relating to his [her] liability for [Type of Tax] taxes due and owing by him [her] to the United States of America for the calendar year(s) ,2 did willfully [(receive) (withhold) (destroy) (mutilate) or (falsify), Describe Book, Document, or Record Involved]3.

             In violation of Title 26, United States Code, Section 7206(5)(B).

                                                                 A True Bill.

 

                                                                                          

                                                                 Foreperson

 

                                     

United States Attorney



[F-84]

NOTES

 

1 Where appropriate, substitute "a compromise"; or "a closing agreement"; or "an offer to enter into a closing agreement".

 

2 If fiscal year is involved, substitute "fiscal year(s) ended , 20__". Fiscal year individual returns must be filed on or before the 15th day of the fourth month after the end of the fiscal year. 26 U.S.C. § 6072(a).

 

3 Where false statement is the crime, substitute "make a false statement to [Name Appropriate Official, with Job Title], at [Place], [Location], wherein [Defendant's Name] stated that [Describe False Statement Relating to the Estate or Financial Condition of Taxpayer], whereas, as he [she] then and there knew, [Describe Correct Fact(s) Relating to False Statement]".


[F-85]

Form 45

 

26 U.S.C. § 7207

False Document Submitted to I.R.S.

Venue in District Where Document Submitted

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7207
________________________ )  

 

 

            The United States Attorney charges:

            That on or about [Month] [Day], [Year], in the District of             , [Defendant's Name], a resident of [City], [State], did willfully deliver and disclose by submitting to an Officer(s) of the Internal Revenue Service, United States Treasury Department, at [Place], [Location], a [Describe Document, e.g., List, Account, Statement, or Other Document].2 [Defendant's Name] knew that the [Description of Document] was fraudulent and false as to a material matter in that [Describe the False Fact(s)], whereas, as he [she] then and there knew, [Describe the Correct Fact(s)].

            In violation of Title 26, United States Code, Section 7207.

                                                                                            

                                                                 United States Attorney

 

NOTES

 

1 Department policy generally limits Section 7207 prosecutions to cases involving the falsification of documents other than U.S. tax returns.

 

2 A separate count should be charged for each false document.

 


[F-86]

Form 46

 

26 U.S.C. § 7207

False Document Submitted to I.R.S.

Venue in District of Mailing

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF

 

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7207
________________________ )  

 

 

            The United States Attorney charges:

            That on or about [Month] [Day], [Year], in the District of             , [Defendant's Name], a resident of [City], [State], did willfully deliver and disclose by mailing and causing to be mailed, to an Officer(s) of the Internal Revenue Service, United States Treasury Department, a [Describe Document, e.g., List, Account, Statement, or Other Document].2 [Defendant's Name] knew that the [Description of Document] was fraudulent and false as to a material matter in that [Describe the False Fact(s)], whereas, as he [she] then and there knew, [Describe the Correct Fact(s)].

            In violation of Title 26, United States Code, Section 7207.

                                                                                              

                                                                 United States Attorney

 

NOTES

 

1 Department policy generally limits Section 7207 prosecutions to cases involving the falsification of documents other than U.S. tax returns.

 

2 A separate count should be charged for each false document.


[F-87]

Form 47

 

26 U.S.C. § 7207

False Documents Submitted to I.R.S.

Venue in District Where Documents Submitted

Tabular Form Information

 

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7207
________________________ )  

 

 

            The United States Attorney charges:

            1.       That on or about the dates hereinafter specified, in the District of

             , [Defendant's Name], a resident of [City], [State], did willfully deliver and disclose by submitting to an Officer(s) of the Internal Revenue Service, United States Treasury Department, at [Place], [Location], documents described below.2 The defendant then and there knew that the documents were fraudulent and false as to a material matter, as set forth below.  

            2.       The allegations of paragraph "1." are repeated and realleged in Counts I through

      , inclusive, of this Information, as though fully set forth therein.

COUNT      DATE OF OFFENSE       DESCRIPTION OF DOCUMENT         FALSITY

I.                  _______________          ___________________________           _________

II.                 _______________          ___________________________           _________

III.                _______________          ___________________________           _________

            In violation of Title 26, United States Code, Section 7207.

 

                                                                                                      

                                                                 United States Attorney

 

 



[F-88]

NOTES

 

1 Department policy generally limits Section 7207 prosecutions to cases involving the falsification of documents other than U.S. tax returns.

 

2 A separate count should be charged for each false document.


[F-89]

Form 48

 

26 U.S.C. § 7207

False Documents Submitted to I.R.S.

Venue in District of Mailing

Tabular Form Information

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7207
________________________ )  

 

 

            The United States Attorney charges:

            1. That on or about the dates hereinafter specified, in the District of

                , [Defendant's Name], a resident of [City], [State], did willfully deliver and disclose

by mailing and causing to be mailed, to an Officer(s) of the Internal Revenue Service, United States Treasury Department, documents described below.2 The defendant then and there knew that the documents were fraudulent and false as to a material matter, as set forth below.

            2. The allegations of paragraph "1." are repeated and realleged in Counts I through

      , inclusive, of this Information, as though fully set forth therein.

 

COUNT      DATE OF OFFENSE       DESCRIPTION OF DOCUMENT         FALSITY

 

I.                _________________         ___________________________         ________

II.               _________________         ___________________________         ________

III.              _________________         ___________________________         ________

 

             In violation of Title 26, United States Code, Section 7207.

 

                                                                                                      

                                                                 United States Attorney

 

 



[F-90]

NOTES

 

1 Department policy generally limits Section 7207 prosecutions to cases involving the falsification of documents other than U.S. tax returns.

 

2 A separate count should be charged for each false document.


[F-91]

Form 49

 

26 U.S.C. § 7210

Failure to Appear in Response to Summons

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7210
________________________ )  

 

 

            The United States Attorney charges:

            On or about [Month] [Day], [Year], in the District of            , [Defendant's Name], a resident of [City], [State], was required under the Internal Revenue laws, by reason of being duly summoned, to appear to testify1 at on that date at the office of . Well knowing and believing all of the foregoing, he [she] willfully failed to appear to testify1 at the time and place required by the summons.

            In violation of Title 26, United States Code, Section 7210.

                                                                                               

                                                                 United States Attorney

 

NOTES

 

1 Where appropriate, add or substitute "and produce [Describe Documents Summoned]".


[F-92]

Form 50

 

26 U.S.C. § 7212(a) "Omnibus" Clause

Corrupt Endeavor to Obstruct or Impede

the Due Administration of the Internal Revenue Laws

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7212(a)
________________________ )  

 

 

            The grand jury charges:

            That beginning on or about [Date], and continuing thereafter up to and including [Date], in the District of ________, [Defendant's Name] did corruptly endeavor to obstruct and impede the due administration of the internal revenue laws by [Describe manner and means of defendant's corrupt obstruction of internal revenue laws, e.g., [FRAUDULENT FORM 1099 SCHEME]: (1) sending to employees of the Internal Revenue Service and others [hereinafter "these individuals"], a request for their Social Security Numbers, Form W-9; (2) sending to these individuals a "Notice of Bill due and payable" demanding them to make payment of a substantial sum of money to [Defendant's Name] whereas these individuals never owed [Defendant's Name] any sum of money; (3) sending to these individuals a Form 1099-MISC reporting "Nonemployee compensation" allegedly paid to them from [Defendant's Name], whereas these individuals never received compensation of any kind from [Defendant's Name]; (4) sending to the Internal Revenue Service copies of the Forms 1099-MISC representing that [Defendant's Name] paid "Nonemployee compensation" to the named recipients of the Forms 1099-MISC, whereas he never paid these individuals compensation of any kind; (5) sending to these individuals a "Past Due Statement," advising them to report on their tax returns the amount stated in the "Notice of Bill due and payable"; (6) sending to the Internal Revenue Service Applications for Reward for Original Information, Form 211, on which [Defendant's Name] claimed money rewards for the reporting of alleged violations of the tax laws allegedly committed by these individuals; and (7) filing with the Internal Revenue Service a false and fraudulent U.S. Individual Income Tax Return, Form 1040, for the calendar year 1989, which claimed a tax refund due of $ , whereas [Defendant's Name] was not entitled to a tax refund in this amount.]

            In violation of Title 26, United States Code, Section 7212(a).


[F-93]

                                                                 A True Bill.

 

                                                                                          

                                                                 Foreperson

 

                            

United States Attorney


[F-94]

Form 51

 

26 U.S.C. § 7215

Failure to Make Trust Fund

Deposit After Notice

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 26 U.S.C. § 7215
________________________ )  

 

 

            The United States Attorney charges:

            1.       During the period , 20__, to , 20__, in the District of ________, [Defendant's Name] was an employer of labor1 required under the provisions of the Internal Revenue Code to collect, account for, and pay over to the United States federal income taxes and Federal Insurance Contributions Act (F.I.C.A.) taxes withheld from wages.

            2.       [Defendant's Name] did fail at the time and in the manner prescribed by the Internal Revenue Code, and Regulations promulgated pursuant thereto, to collect, truthfully account for, and pay over and to make deposits and payments of the said withheld taxes to the United States, which were due and owing for the quarters ending , 20__, , 20__, , 20__, and , 20__.2

            3.       On , 20__, [Defendant's Name] was notified of such failure by notice delivered in hand to him [her] as provided by Title 26, United States Code, Section 7512. The notice advised him [her] that he [she] was required to collect the aforesaid taxes that became collectible after delivery of the notice and, not later than the end of the second banking day after the collection, to deposit the taxes into a separate bank account established by him [her] in trust for the United States. The notice further advised [Defendant’s Name] that the taxes were required to be kept in that bank account until paid over to the United States.

            4.       Within the District of ________, [Defendant's Name] unlawfully failed to comply with the provisions of Title 26, United States Code, Section 7512, in that, after receiving delivery of the notice referred to in paragraph "3.", he [she] paid wages and was required to collect and deposit the said taxes, but failed to deposit said taxes into a separate bank account in trust for the United States, by the dates and in the amounts specified below:


[F-95]

COUNT 

DATE WAGES

PAID                  

DATE DEPOSIT

REQUIRED        

AMOUNT OF

DEPOSIT REQUIRED

I. ________________ ______________ $__________________
II. ________________ ______________ $__________________
III. ________________ ______________ $__________________
IV. ________________ ______________ $__________________

             In violation of Title 26, United States Code, Section 7215.

 

                                                                                                      

                                                                 United States Attorney

 

NOTES

 

1 If the employer is other than a sole proprietorship (e.g., a corporation, partnership, or joint venture), the relationship of the defendant to the employer-entity, which makes him the responsible person, should be alleged in paragraphs 1, 2, and 3, by substituting "[Defendant's Name], who was the [Position Held in Company] of [Name of Company], a [Type of Company, e.g., Corporation, Partnership, etc.], and an employer of labor".

 

2 Quarters prior to notice for which there was a failure to collect, account for, and pay over federal income and F.I.C.A. taxes withheld from wages.


[F-96]

Form 52

 

18 U.S.C. § 287

False Claim for Refund

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE _____________ DISTRICT OF _________________

 

UNITED STATES OF AMERICA   
)
)
v.
)
No. _______________
)
18 U.S.C. § 287
________________________
)

 

 

            The grand jury charges:

            That on or about [Month] [Day], [Year], in the __________ District of __________, [Defendant's Name], a resident of [City], [State], made and presented to the Internal Revenue Service, an agency of the United States Department of the Treasury, a claim against the United States for payment of a refund of taxes in the amount of $ __________, which he [she] then and there knew to be false, fictitious, and fraudulent. [Defendant’s Name] made the claim by preparing and causing to be prepared,1 and presenting and causing to be presented to said agency, a U.S. Individual Income Tax Return, Form 1040,2 for the year ______ that requested a refund to which the defendant knew he[she] was not entitled.

 

            In violation of Title 18, United States Code, Section 287.

                                                                 A True Bill.

 

                                                                                     

                                                                 Foreperson

 

                                     

United States Attorney

 



[F-97]

NOTES

 

 

1 If venue is to be placed in the district of filing, modify this form in accordance with language in Form 2 and related footnote 2. If venue is based on mailing, substitute "by mailing and causing to be mailed".

 

2 The appropriate IRS form should be designated here -- e.g., U.S. Corporation Income Tax Return, Form 1120.


[F-98]

Form 53

 

18 U.S.C. § 286/287

Conspiracy to File False Claims for

Refund/False Claims for Refund

 

NOTE:          This indictment provides sample language to charge violations of 18 U.S.C. 286 and 287 in the most commonly encountered type of Electronic Filing (ELF) scheme. Modification of the language will be necessary in cases involving different fact patterns. Modification of the format used may be desirable to conform to local practice.

 

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE__________ DISTRICT OF __________

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. ______________
  ) 18 U.S.C. § 286:
  ) Conspiracy; 18 U.S.C.
________________________, ) § 287: False Claim to
________________________, ) a Government Agency
________________________, )  

 

 

            The grand jury charges:

COUNT ONE

[18 U.S.C. § 286]

            Beginning in or about [ month], 20__, and continuing until on or about [ month], 20__, within the __________ District of __________, (and elsewhere, if appropriate) defendants [name(s) of defendant(s)], and others, both known and unknown to the grand jury, agreed, combined, and conspired to defraud the United States by obtaining and aiding to obtain the payment or allowance of [a] false, fictitious, and fraudulent claim[s] on behalf of themselves and others by submitting a false claim[s] for income tax refund with the United States Department of Treasury through the Internal Revenue Service.

 

            The conspiracy was accomplished, in part, by the following acts:

 

[Describe how the conspiracy was accomplished or intended to be accomplished.  Some examples of acts undertaken follow.]

  1.  Defendants [insert relevant names] recruited customers into the [fraudulent Form 1099-OID] scheme through seminars and one-on-one consultations.
  2. Defendants [insert relevant names] charged each scheme customer up to [$x,xxx] [describe what customer got for the fee; avoid referring to membership].
  3. Defendants [insert relevant names] paid a fee to others for referring a paying customer.
  4. Defendants [insert relevant names] required that scheme customers pay them a portion of the fraudulently-obtained refunds.
  5. Defendants [insert relevant names] required that each scheme customer provide specific paperwork, including but not limited to, copies of his or her driver’s license and social security card; a voided check;  IRS transcripts and tax returns for specific years; a signed IRS Form 8821, granting Defendant permission to inspect his/her IRS records; and a promissory note and trust deed for each piece of real property that the customer owned.
  6. Defendants [insert relevant names] electronically transmitted the fraudulent [Form 1099-OID] information to the IRS.          

 

[Other schemes may include such acts as using stolen Social Security Numbers or claiming as dependents individuals who are not dependents of the filer.  Include additional acts if warranted.]            
            
                        In violation of Title 18, United States Code, Section 286.

 


[F-102]

COUNTS TWO THROUGH TEN

[18 U.S.C. §§ 287, 2]

            On or about the dates listed below, within the __________ District of __________, [Defendant(s) Name(s)] made and presented, and caused to be made and presented, to the Internal Revenue Service, an agency of the United States Department of the Treasury, claims against the United States for payment of a refund of taxes, which he/she (they) knew to be false, fictitious, and fraudulent. [Defendant(s) Name(s)] made the claims by preparing and causing to be prepared,1 and presenting and causing to be presented to said agency, U.S. Individual Income Tax Returns, Forms 1040,2 for the individual and amounts described below knowing that the claim was false, ficticious, and fraudulent in that the named individual was not entitled to the refund that was being requested.

 

                                                           TAX              REFUND             AMOUNT

COUNT        NAME                          DATE            YEAR                  CLAIMED

 

TWO         ___________               __/__/__       _______                  $ __________

THREE      ___________              __/__/__        _______                  $ __________

FOUR        ___________              __/__/__       _______                  $ __________

FIVE          ___________              __/__/__       _______                  $ __________

SIX            ___________              __/__/__       _______                  $ __________

SEVEN      ___________              __/__/__       _______                  $ __________

EIGHT       ___________              __/__/__       _______                  $ __________

NINE         ___________              __/__/__       _______                  $ __________

TEN           ___________              __/__/__       _______                  $ __________

 

            In violation of Title 18, United States Code, Section 287 and Section 2.

 

                                                                 A True Bill.

 

                                                                                   

                                                                 Foreperson

 

 

                                     

United States Attorney

 

NOTE

 

1 If venue is to be placed in the district of filing, modify this form in accordance with language in Form 2 and related footnote 2. If venue is based on mailing, substitute "by mailing and causing to be mailed".

 

2 The appropriate IRS form should be designated here -- e.g., U.S. Corporation Income Tax Return, Form 1120.


[F-104]

Form 54

 

18 U.S.C. § 371

Conspiracy To Defraud United States

Impede And Impair I.R.S. -- Klein Conspiracy

 

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. ______________
  ) 18 U.S.C. § 371
________________________ )  

 

 

            The grand jury charges:

 

THE CONSPIRACY1

            1.       From on or about [ beginning date], the exact date being unknown to the Grand Jury, and continuing thereafter up to and including the date of this indictment2, in the __________ District of ____________________,

    [ first defendant's name],

    [ second defendant's name],

    [ third defendant's name],

defendants herein, did unlawfully, voluntarily, intentionally and knowingly conspire, combine, confederate, and agree together and with each other and with other individuals both known and unknown to the Grand Jury to defraud the United States for the purpose of impeding, impairing, obstructing, and defeating the lawful Government functions of the Internal Revenue Service of the Treasury Department in the ascertainment, computation, assessment, and collection of the revenue: to wit, income taxes [or other relevant taxes, e.g., excise taxes].3

 

PARTIES, PERSONS AND ENTITIES

            At all relevant times,

            2.       [E.g., Defendants John Smith and Tom Smith were president and vice-president of Smith, Inc., a corporation, and each owned 50% of the stock of Smith, Inc.]

            3.       [E.g., Defendant Sam Jones was a certified public accountant who prepared the income tax returns of Smith, Inc., a corporation, and its officers.]


[F-105]

            4.       [E.g., Smith, Inc., was a Massachusetts corporation, formed in 1975 by defendant John Smith to market real estate limited partnerships.]

            5.       [Continue to describe all defendants and all persons and entities that are significant to an understanding of the conspiracy.]

 

MANNER AND MEANS BY WHICH THE

CONSPIRACY WAS CARRIED OUT

            The manner and means by which the conspiracy was sought to be accomplished included, among others, the following:

            6.       [Describe manner or means, e.g., To divert corporate receipts to their own use, defendant John Smith presented false books and records to the corporate accountant for use in preparing the corporate income tax returns of Smith, Inc., for the calendar years 1988, 1989, and 1990.]

            7.       [E.g., By backdating documents so as to conceal from the Internal Revenue Service defendant John Smith's ownership and interest in real property.]

            8.       [E.g., By making false statements and representations to agents of the Internal Revenue Service for the purpose of concealing the interest of defendant John Smith in property, stock, etc.]

            9.       [Continue to describe general manner and means used to carry out the

conspiracy.]4

OVERT ACTS

            In furtherance of the conspiracy, and to effect the objects thereof, the following overt acts were committed in the __________ District of ____________________, and elsewhere:

            10.     [E.g., On or about July 20, 1988, defendant Tom Smith and Jane Smith met in the offices of Smith Realty Co. at 33 Main Street, Boston, Massachusetts, and discussed how to backdate real estate contracts.]

            11.     [E.g., In or about the week of July 20, 1988, defendants John Smith and Tom Smith went to the A & B Bank in Boston, Massachusetts, and removed cash from the safe deposit box of defendant John Smith.]


[F-106]

            In violation of Title 18, United States Code, Section 371.

                                                                 A True Bill.

 

                                                                 ____________________

                                                                 Foreperson

 

                            

United States Attorney

 

NOTES

 

1 It is suggested that the paragraphs of the indictment be numbered sequentially from beginning to end even though the indictment will have different sections. This will eliminate confusion when reference is made to a particular portion or paragraph of the indictment.

 

2 Substitute appropriate date if the conspiracy ended before the date of the indictment.

 

3 Strike the remaining portion of this paragraph beginning with the phrase "to defraud the United States" and substitute appropriate language if conspiracy is to commit a substantive offense. E.g., "to commit offenses against the United States: to wit, to violate Title 26, United States Code, Sections 7201 and 7206(1)." In the case of a conspiracy to commit a substantive offense, this paragraph must allege that the defendant had the intent required for the substantive offense. United States v. Bedford, 536 F.3d 1148, 1155 (10th Cir. 2008).

 

            The Tax Division advises against charging a conspiracy to defraud and a conspiracy to commit substantive tax offenses in the same count or indictment. This is rarely necessary and tends to unduly complicate the trial, especially with respect to the jury instructions.

 

4 When charging a Klein conspiracy (and not a conspiracy to commit a substantive offense), the means must include deceit, craft, and/or trickery, or at least means that are dishonest. Hammerschmidt v. United States, 265 U.S. 182, 188 (1924).

 


[F-107]

Form 55

 

18 U.S.C. § 1001

False Statement or Representation

Made to Department/Agency of U.S.

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. _______________
  ) 18 U.S.C. § 1001
________________________ )  

 

 

            The grand jury charges:

            That on or about [Month] [Day], [Year], [Defendant's Name], a resident of [City], [State], did willfully and knowingly make and cause to be made a materially false, fictitious, and fraudulent statement(s) and representation(s) in a matter within the jurisdiction of the executive, legislative, or judicial branch of the Government of the United States by [Describe False Statement or Representation and Describe Official to Whom False Statement Was Made], at [Place], [Location], in the District of . The statement[s] and representation[s] were false because, as [Defendant's Name] then and there knew, [Describe Correct Fact(s) Regarding the False Statement or Representation].

            In violation of Title 18, United States Code, Section 1001.

                                                                 A True Bill.

 

                                                                                          

                                                                 Foreperson

 

                                     

United States Attorney


[F-108]

Form 56

 

18 U.S.C. § 1001

False Document Submitted

to Department/Agency of U.S.

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. _____________
  ) 18 U.S.C. § 1001
________________________ )  

 

 

            The grand jury charges:

            That on or about [Month] [Day], [Year], [Defendant's Name], a resident of [City], [State], did willfully and knowingly make and cause to be made, and use and cause to be used, in a matter within the jurisdiction of the executive, legislative, or judicial branch of the Government of the United States, a false writing or document, knowing the same to contain a materially false, fictitious, and fraudulent statement. [Defendant's Name] submitted [Describe False Document and False Statement(s) Within Document and Describe Official to Whom the False Document Was Submitted], at [Place], [Location], in the District of ________, well knowing and believing [Describe Correct Fact(s) Regarding False Document].

            In violation of Title 18, United States Code, Section 1001.

                                                                 A True Bill.

 

                                                                                          

                                                                 Foreperson

 

                            

United States Attorney


[F-109]

Form 57

 

18 U.S.C. § 1001

Falsify, Conceal, or Cover Up

by Trick, Scheme, or Device a Material Fact

 

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. ______________
  ) 18 U.S.C. § 1001
________________________ )  

 

 

            The grand jury charges:

            From on or about [Month] [Day], [Year], to on or about [Month] [Day], [Year], in the             District of ________, [Defendant's Name], a resident of [City], [State], did willfully and knowingly falsify, conceal, and cover up, by trick, scheme, or device a material fact, in a matter within the jurisdiction of the executive, legislative, or judicial branch of the Government of the United States. [Defendant's Name][Describe Nature of Scheme or Device to Conceal, Including Name and Title of any IRS Employee to Whom False Statement(s) or Representation(s) Were Made; Nature of False Statement(s) or Representation(s); Place and Location Where False Statement(s) or Representation(s) Were Made; and/or Specific False Document(s) Submitted],1 well knowing and believing [Describe Correct Facts Relating to False Statement(s), Representation(s), and/or Document(s)].2

            In violation of Title 18, United States Code, Section 1001.

                                                                 A True Bill.

 

                                                                                          

                                                                 Foreperson

 

                         ____   

United States Attorney

 



[F-110]

NOTES

 

1 E.g., "by representing to John Smith, Revenue Officer, Internal Revenue Service, at 33 Main Street, Boston, Massachusetts, that the deductions claimed for contributions were in the amount of $ _____ and that eight checks drawn on account number _________ at __________ Bank were issued to make the contributions in the amounts represented on said checks".

 

2 E.g., "the said eight checks had been altered and were false as to (amounts, payees, dates, etc.)".


[F-111]

Form 58

 

18 U.S.C. § 1956(a)(1)(A)(ii)

Laundering of Monetary Instruments

 

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE DISTRICT OF

 

UNITED STATES OF AMERICA    )  
  )  
v.
) No. ________________
  ) 18 U.S.C. §§ 1956(a)(1)(A)(ii)
________________________ ) and 2
     

 

            The grand jury charges:

            On or about [Date], in the District of ________, [Defendant(s) Name(s)] did knowingly and willfully conduct and attempt to conduct a financial transaction affecting interstate and foreign commerce, to wit, [Description of Financial Transaction], which involved the proceeds of a specified unlawful activity, that is [Describe Specified Unlawful Activity]. Defendant acted with the intent to engage in conduct constituting a violation of [26 U.S.C. § 7201] [26 U.S.C. § 7206]1 to wit, [Describe Conduct]. While conducting and attempting to conduct that financial transaction, [Defendant's Name] then and there knew that the property involved in the financial transaction, that is [Funds]2 [Monetary Instruments]3 in the amount of $ , represented the proceeds of some form of unlawful activity.

            All in violation of Title 18, United States Code, Sections 1956(a)(1)(A)(ii) and 2.

                                                                 A True Bill.

 

                                                                                          

                                                                 Foreperson

 

                                      

United States Attorney



[F-112]

NOTES

 

1 Choose one or both. If both are used, set forth in the conjunctive.

 

2 Select one. Remember monetary instrument is a defined term in § 1956(c)(5), whereas "funds" is undefined.

 

3 If the activity described in this paragraph is intended to cover more than one count, this last phrase can be redrafted in tabular form as follows: "That is, [Funds], [Monetary Instruments] in the amounts set forth below:

 

Count                        Approximate Dollar Amounts

 

I.                              $______________

 

II.                             $______________

 

III.                            $______________