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457

L: Post-Notice Following Emergency Access—Form DOJ-472

RFPA

Form DOJ-472--Post-Notice Following Emergency Access

UNITED STATES DEPARTMENT OF JUSTICE

Washington, D.C. 20530

POST-NOTICE FOLLOWING EMERGENCY ACCESS

Dear ________________________ :

(Name of Customer)

Records concerning your transactions held by the financial institution named in the attached request were ____________________________ under Section 1114(b)

(Government Agency)

of the Right To Financial Privacy Act of 1978, 12 U.S.C. Secs. 3401-3422, on ____________ ___ , 19 ___ for the following (Date)

purpose: _______________________________________________________

________________________________________________________________

Emergency access to such records was obtained on the grounds

that: __________________________________________________________

________________________________________________________________

____________ ____ , 19 ___ ______________________________

(Date) (Name and Title of Official)

___________________________ (Government Agency)

___________________________

(Telephone)

___________________________

(Address)

Attachment

Sec. 1109(c) of the Right To Financial

FORM DOJ-472

Privacy Act, l2 U.S.C. Sec. 3409(c)