UNITED STATES DISTRICT COURT FOR THE
___________DISTRICT OF __________
UNITED STATES OF AMERICA, CR
v. CERTIFICATE FOR
________________, United States Attorney for the District of _____________, pursuant to authority granted by the Attorney General, hereby certifies to the Court that the State of __________ either does not have jurisdiction or refuses to assume jurisdiction or lacks available programs and services adequate for the needs of the juvenile ________________________________________ who is charged with ______________________________________________
and that there is a substantial federal interest in the case or the offense to warrant the exercise of federal jurisdiction.
Dated this ____ day of ________________, 19___.
United States Attorney