2447. Form Indictment -- Intentional Prohibited Service By Convicted Individual For Sentences Entered After October 12, 1984

(29 U.S.C. § 1111)

ERISA Sec. 411

The Grand Jury charges that:

On or about (sentence date), (Defendant) was convicted of (crime, e.g. embezzlement) in violation of (statute, e.g. Title 18, United States Code, Section 664) in (United States v. Defendant, District and Cr. #) [and was released from imprisonment resulting from such conviction on (date)].*
Following said conviction (Defendant) was prohibited from serving in any capacity described in Section 411 of the Employee Retirement Income Security Act (29 U.S.C. § 1111) for a period extending until 13 years after such conviction [or after the end of imprisonment resulting from such conviction, which ever occurred later].*
From on or about (date) until on or about (date), (Defendant) intentionally served in the ______ District of _____ in a prohibited capacity(ies), that is,
1. [(administrator) (fiduciary) (officer) (trustee) (custodian) (counsel) (agent) (employee) (representative) of] [(consultant) (advisor) to] [in a capacity that involved decision making authority or custody or control of the moneys, funds, assets, or property of]
  (name of plan), an employee benefit plan subject to Title I of the Employee Retirement Income Security Act, Title 29, United States Code, Sections 1001 et seq.
All in violation of Title 29, United States Code, Section 1111.
* In paragraphs 1 and 2, use the language in brackets only IF imprisonment, including revocation of parole, supervised release or probation which resulted in imprisonment, occurred.