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518

Order for Disclosure of Returns and Return Information


          IN THE UNITED STATES DISTRICT COURT FOR THE
                  _______ DISTRICT OF ________
                      _________ Division

UNITED STATES OF AMERICA         )
                                 )
          v.                     )   GRAND JURY NO.
                                 )
JOHN DOE NO.


           ORDER FOR DISCLOSURE OF

                 RETURNS AND RETURN INFORMATION



     On this _____ day of ______, 19___, comes for the attention of the
Court the application of the United States Attorney for the ____________
District
of _____________ for an ex parte order, pursuant to 26 U.S.C.
6103(i)(1), directing the Internal Revenue Service to disclose returns and
return
information of:



 NAME:

     ADDRESS:

   SOCIAL SECURITY NO.:


for taxable period ________________.  After examining the application the
Court
finds:

      (1) There is reasonable cause to believe, based upon information
believed to be reliable, that violations of Federal criminal statutes,
namely
 U.S.C. Section     ;    U.S.C. Section     ;    U.S.C. Section     ;
U.S.C.
Section     , have been committed.

          (2) There is reasonable cause to believe that the returns and
return information are or may be relevant to a matter relating to the
commission
of such acts.

          (3) The returns and return information are sought exclusively for
use in a Federal criminal proceeding concerning such acts.

          (4) The information sought to be disclosed cannot reasonably be
obtained, under the circumstances, from another source.

     The Court further finds that applicant is an employee of the United
States Attorney's Office for the ____________ District of ______________ and
is
primarily and directly engaged in, and the information sought is solely for
their
use in, investigating the above-mentioned violations of    U.S.C. Section

    , and that the application is authorized by the United States Attorney
for
the _________ District of ______________.

     It is further ORDERED that the Internal Revenue Service (1) disclose
such returns and return information of:

     NAME:

     ADDRESS:

     SOCIAL SECURITY NO.:



for the taxable period as have been filed and are on file with the Internal
Revenue Service; (2) certify where returns and return information described
above
have not been filed or are not on file with the Internal Revenue Service
that no
such returns and return information have been filed or are on file; (3)
disclose
such returns and return information described above as come into the
possession
of the Internal Revenue Service subsequent to the date of this order, but
for not
longer than 90 days thereafter; (4) disclose such returns and return
information
and make such certification only to applicant, to Special Agent
_____________________________ and to no other person; (5) disclose no
returns or
return information not described above.

     It is further ORDERED that applicant and any officer or employee of any
Federal agency who may be subsequently assigned in this matter shall use the
returns and return information disclosed solely in investigating the
above-mentioned violations of  U.S.C. Section , and such other violations of
any
Federal criminal statutes, although presently unknown, as are discovered in
the
course of this investigation of       , and preparing the matter for trial,
and
that no disclosure be made to any other person except in accordance with the
provision of 26 U.S.C. 6103 and 26 C.F.R. 301.6103(i)(1).


                              ___________________________________
UNITED STATES DISTRICT JUDGE DATED: _____________________ VERIFICATION I, ________________, being first duly sworn, depose and say that I am an Assistant United States Attorney for the __________ District of ___________ and that the foregoing Application is made on the basis of information officially furnished and upon the basis that such information is true as I verily believe. _________________________________
Assistant United States Attorney Subscribed and sworn to before me this _____ day of _________, 19_____. My Commission Expires: _____________________________
Notary Public