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453

H: Order—Form DOJ-468

RFPA

Form DOJ-468-- Order

IN THE UNITED STATES DISTRICT COURT

FOR THE _______________ DISTRICT OF ________________

In Re __________________ Miscellaneous No. ______________

ORDER

Upon consideration of the application of the United States for an Order pursuant to Section 1109 of the Right To Financial Privacy Act of 1978, 12 U.S.C. Sec. 3409, and finding that:

  1. the investigation being conducted is within the lawful jurisdiction of the government authority seeking access;

  2. there is reason to believe that the records being sought are relevant to a legitimate law enforcement inquiry; and

  3. there is reason to believe that customer notice will result in: (state specific grounds relied upon under 12 U.S.C. Sec. 34O9(a)(3))

________________________________________________________________

________________________________________________________________

it is ORDERED, that notification of ____________________________

(Name of Customer)

that his/her records have been sought or obtained may be delayed for no more than ________ days, and it is further ORDERED, that ___________________________________________ ,

(Name of Financial Institution)

its officers, employees, and agents are prohibited, for a pe of this Order from disclosing that records pertaining to __________________________

(Name of Customer)

have been released or that a request for such records has been made.

DATED, this _____ day of _____ , l9__ ______________________________

UNITED STATES DISTRICT JUDGE OR UNITED STATES MAGISTRATE

Sec. 1109 of the Right to Financial

FORM DOJ-468

Privacy Act of l978, 12 U.S.C. Sec. 3409