I, _______________, United States Attorney for the _________ District of ___________, pursuant to 26 U.S.C. 6103(i)(5), hereby authorize the attached Application for Ex Parte Order for Disclosure of Tax Returns and Return Information of ______________________________ for the taxable periods _______________________ made by ____________________________,
Assistant United States Attorney for the ___________ Division of the _________ District of ___________.
Date (Name of United States Attorney)
UNITED STATES ATTORNEY