451. F: Sworn Statement of Movant—Form DOJ-466

RFPA

Form DOJ-466 -- Sworn Statement of Movant

IN THE UNITED STATES DISTRICT COURT

FOR THE _____________________ DISTRICT OF_______________________

(Name of District) (State in which

Court is located)

_______________________

(Customer's Name)

Movant

v.

Miscellaneous No.

UNITED STATES DEPARTMENT OF JUSTICE SWORN STATEMENT OF MOVANT

Respondent

I, _______________________________, (am presently/was previously)

(Customer's Name) (Indicate One)

a customer of ______________________________________________________

(Name of Financial Institution)

and I am the customer whose records are being requested by the Government.

The financial records sought by ____________________________________

(Name of Government Agency)

are not relevant to the legitimate law enforcement inquiry stated in the Customer Notice that was sent to me because ____________________________________________________________

____________________________________________________________________, or should not be disclosed because there has not been substantial compliance with the Right To Financial Privacy Act of 1978 in that

____________________________________________________________________

____________________________________________________________________, or should not be disclosed on the following other legal basis _________________________________

____________________________________________________________________.

I declare under penalty of perjury that the foregoing is true and correct.

_______________ ____, 19____________________________

(Date) (Customer's Signature)

§ 1110 of the Right to Financial

FORM DOJ-466

Privacy Act, 12 U.S.C. § 3410