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