IN THE UNITED STATES DISTRICT COURT FOR THE
_______ DISTRICT OF ________
UNITED STATES OF AMERICA
v. MISCELLANEOUS NO.
APPLICATION FOR EX PARTE ORDER TO
DISCLOSE RETURNS AND RETURN INFORMATION
Comes now the United States of America, through its attorneys ______________, United States Attorney for the _______ District of ___________, and __________________________, Assistant United States Attorney, pursuant to 26 U.S.C. 6103(i)(5), and makes application to the Court for an ex parte order directing the Internal Revenue Service (IRS) to disclose to applicant (and others hereinafter named) returns and return information of:
SOCIAL SECURITY NUMBER:
which returns and return information are described as those returns and return information for the taxable period(s)
In support of its application applicant alleges and states the following:
- A federal arrest warrant relating to the commission of the Federal felony offense(s) of (LIST OF OFFENSE(S)) __________ _________________________________________________________________ _________________________________________________________________
has been issued for the individual named above who is a fugitive from justice.
- There is reasonable cause to believe that such return or return information may be relevant in determining the location of such individual. (STATE FACTS SUFFICIENT TO ALLOW THE COURT TO SO FIND.)
- The returns of such individual or return information with respect to such individual is sought exclusively for use in locating such individual. No disclosure will be made except in accordance with the provisions of 26 U.S.C. § 6103.
Applicant further alleges and states that:
is involved in locating the fugitive.
This application is authorized by __________________, United States Attorney. Therefore, applicant prays that this Court enter an order, ex parte, on this application granting disclosure by the Internal Revenue Service of the returns and return information specified in this application.
(Name of United States Attorney)
UNITED STATES ATTORNEY
Assistant United States Attorney
[cited in Criminal Resource Manual 510]