|
IN THE UNITED STATES DISTRICT COURT FOR THE
_______ DISTRICT OF ________
___________ Division
UNITED STATES OF AMERICA
v. MISCELLANEOUS NO.
APPLICATION FOR EX PARTE ORDER TO
DISCLOSE RETURNS AND RETURN INFORMATION
Comes now the United States of America, through its attorneys
______________, United States Attorney for the _______ District of
___________,
and __________________________, Assistant United States Attorney, pursuant
to 26
U.S.C. 6103(i)(5), and makes application to the Court for an ex
parte order directing the Internal Revenue Service (IRS) to disclose
to
applicant (and others hereinafter named) returns and return information of:
NAME:
ADDRESS:
SOCIAL SECURITY NUMBER:
which returns and return information are described as those returns and
return
information for the taxable period(s) ______
_____.
In support of its application applicant alleges and states the
following:
- A federal arrest warrant relating to the commission of the Federal
felony
offense(s) of (LIST OF OFFENSE(S)) __________
_________________________________________________________________
_________________________________________________________________
has been issued for the individual named above who is a fugitive from
justice.
- There is reasonable cause to believe that such return or return
information
may be relevant in determining the location of such individual. (STATE
FACTS
SUFFICIENT TO ALLOW THE COURT TO SO FIND.)
- The returns of such individual or return information with respect to
such
individual is sought exclusively for use in locating such individual. No
disclosure will be made except in accordance with the provisions of 26
U.S.C.
§ 6103.
Applicant further alleges and states that:
NAME:
TITLE:
AGENCY:
is involved in locating the fugitive.
This application is authorized by __________________, United States
Attorney. Therefore, applicant prays that this Court enter an order,
ex
parte, on this application granting disclosure by the Internal
Revenue
Service of the returns and return information specified in this application.
Respectfully submitted,
(Name of United States Attorney)
UNITED STATES ATTORNEY
By: ________________________________
Assistant United States Attorney
[cited in Criminal Resource Manual 510] |