Form DOJ-465 -- Motion for Order Pursuant to Customer Challenge Provisions of the Right to Financial Privacy Act of 1978
IN THE UNITED STATES DISTRICT COURT
FOR THE _______________ DISTRICT OF ________________
(Name of District) (State in which
Court is located)
MOTION FOR ORDER PURSUANT TO CUSTOMER
v. CHALLENGE PROVISIONS OF THE RIGHT TO FINANCIAL
U.S. DEPARTMENT OF JUSTICE
PRIVACY ACT of 1978 Respondent.
______________________________ hereby moves this
Court, pursuant to Section 1110 of the Right To Financial Privacy Act of 1978, 12 U.S.C. Sec. 3410, for an order preventing the government from obtaining access to my financial records. The agency seeking access is _______________________________.
(Name of Government Agency)
My financial records are held by _____________________________ .
(Name of Financial Institution)
In support of this motion, the Court is respectfully referred to my sworn statement filed with this motion.
(Your signature) (Your Name)
___________________________ ______________________ (Your Address) (Your Telephone #)
CERTIFICATE OF SERVICE
I have mailed or delivered a copy of this motion and the attached sworn statement to ____________________________________ (Name of Official listed at item 3 of Customer Notice)
on __________ ____ , l9 ___ .
Sec. 1110 of the Right to Financial Privacy
Act of 1978, 12 U.S.C. Sec. 3410