Perjury CasesSample Indictment18 USC 1621
All in violation of 18 U.S.C. § 1621.
- On or about the ______ day of ____________, 19__, in the
__________________ District of __________________, JOHN DOE, did submit a
material written application for a license from the _________ Department,
executed under penalty of perjury under the format of 28 U.S.C. § 1746,
which he did willfully and knowingly state material matter which he did not
believe to be true, that is to say:
- At the time and place aforesaid the ___________ Department, did
require that applications for licenses granted by it be in writing and
in the format provided by 28 U.S.C. § 1746. It was material to such
application that the applicants state if they had ever applied for such a
in the past.
- At the time and place aforesaid, JOHN DOE, submitted a signed
application for a license to the _____________ Department, which contained
following statement: "I declare under penalty of perjury that the forgoing
true and correct. Executed on _________. Signature ________________." The
application signed and submitted by JOHN DOE, did falsely state that he had
made such an application in the past.
- The aforesaid statement in the application signed and submitted by
JOHN DOE, as he then and there well knew and believed, was false in that on
about ______________, 19__, JOHN DOE, did submit an application to the
________________ Department for a license.
[cited in USAM 9-69.200]