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464

Affidavit—Form Q-3

RFPA

Form Q-3 -- Affidavit

IN TME UNITED STATES DISTRICT COURT

FOR THE _______ DISTRICT OF _______

IN RE: GRAND JURY SUBPOENAS

DUCES TECUM, MISC. NO. _____________

(INSERT DATE OF SUBPOENA)

SAMPLE

AFFIDAVIT

I HEREBY CERTIFY that on this ____ day of ________, l981, before me, a Notary Public in and for the City of (insert name of city and state), personally appeared (name of affiant) and made oath in due form of law as follows:

  1. The affiant is a Criminal Investigator employed by the (insert name of agency) and assigned the responsibility of assisting the (insert month and year) Term ______ Grand Jury in its investigation of certain offenses against the Federal criminal laws involving (insert brief description of nature of investigation).

  2. With the assistance of the affiant, the United States Attorney, and Assistant United States Attorney (insert name of Assistant U.S. Attorney), the Grand Jury is continuing an investigation begun by the (insert name of agency) into allegations that (describe allegations under investigation by the grand jury).

  3. Notification of service of the subpoena duces tecum upon the (insert name of bank) will directly alert several persons, including (insert name), to the existence, and perhaps to the nature, of the Grand Jury's investigation. Such notification (will seriously jeopardize the undercover investigative efforts presently conducted by the (insert name of agency) and) will impair the ability of the Grand Jury to obtain testimony and other evidence concerning the violations of federal law now under investigation. Consequently, the government has sought the issuance of an Order, under the terms of the Right to Financial Privacy Act, Title 12, United States Code, Section 3401, et seq., the Court's inherent poweWrits Act, Title 28, United States Code, Section 1651, to delay for 90 days the notification of any customer of the financial institution of the fact of service of the subpoena; of the nature of the documents subpoenaed; and of the fact that such records have been produced in compliance with the terms of the subpoena.

  4. The Government will move the Court to vacate the Order as expeditiously as practicable to limit as much as possible the potential infringement upon the rights of the Bank to speak freely about the subpoena with which it has been served.

_________________________
(INSERT NAME OF AFFIANT)

_________________________
NOTARY PUBLIC

MY COMMISSION EXPIRES: _________________________