150. Certification Form

               IN THE UNITED STATES DISTRICT COURT
           FOR THE ___________ DISTRICT OF ___________
                     _____________ DIVISION

UNITED STATES OF AMERICA           *  UNDER SEAL
                                   *
v.                                 *  NO.
                                   *
[A.B.C., Male Juvenile             *
(INSERT JUVENILE'S INITIALS OR     *
OTHER NON-IDENTIFYING INFORMATION] *

             CERTIFICATION TO PROCEED UNDER THE
        JUVENILE JUSTICE AND DELINQUENCY PREVENTION ACT,
                18 U.S.C. § 5031 ET SEQ.

     COMES NOW, the United States Attorney for the __________ District of
________, after investigation of the matters described herein, and with the
delegation of the Attorney General of the United States and pursuant to Title
18, United States Code, Section 5032, certifies to this Court as follows:

     1.  This certification is made pursuant to the requirements under Title
18, United States Code, Section 5032 of the Juvenile Justice and Delinquency
Prevention Act (18 U.S.C. §§ 5031-42), hereafter referred to as
"the
Act."  [Insert juvenile's initials, etc.], Defendant herein, has been
charged by the United States with violating
__________________________________________, which
are classified as felony crimes of violence or offenses described in Title 21,
United States Code, Section 841 [or other enumerated offenses as
applicable].

     2.  Defendant is a "juvenile" as that term is defined in the Act, in
that he has not yet attained the age of twenty-one, and is accused of
committing acts of juvenile delinquency under Title 18, United States Code,
Section 5032, as described in paragraph 1 herein.

     3.  There is substantial Federal interest in the case, or the
offense(s), to warrant the exercise of federal jurisdiction due to
__________________________________________.

     4.  [and, if applicable:] Furthermore, [the State of _________
does not have available programs and services adequate for the needs of
juveniles, or] the juvenile court or other appropriate state court does not
have jurisdiction or refuses to assume jurisdiction over Defendant with
respect to said alleged acts of juvenile delinquency.

     5.  The United States Attorney, in filing this Certification, acts in
delegation of authority of the Assistant Attorney General of the Department of
Justice pursuant to Title 18, United States Code, Section 5032; Title 28, Code
of Federal Regulations, Section 0.57; and, by Memorandum of the Assistant
Attorney General which is attached to this Certification as Attachment A and
made a part hereof for all purposes.

     WHEREFORE, the United States Attorney now certifies to this Court that
jurisdiction over the defendant as a juvenile committing acts of juvenile
delinquency is proper in this Court in accordance with Title 18, United States
Code, Section 5032.


Respectfully submitted,

_____________________________
UNITED STATES ATTORNEY