On or about the ______day of ________ , in the _________District of_____,
JOHN DOE, defendant herein, knowingly and fraudulently made a false material statement under oath in and in relation to a case under Title 11, In re: John Doe, Case No. ______, by falsely testifying under oath in a proceeding before the case trustee at a meeting of creditors that he did not own any shares of XYZ Company when in fact the defendant knew that he owned 200 shares of XYZ Company.
All in violation of 18 U.S.C. § 152.
[cited in USAM 9-41.001]