On or about the _______day of _______ , in the ___________District of __________,
JOHN DOE, defendant herein, knowingly and fraudulently made a material false declaration, certificate and verification under the penalty of perjury, as permitted under Section 1746 of Title 28, in and in relation to a case under Title 11, In re John Doe No._________, by submitting Schedules of Assets and Liabilities and a Statement of Financial Affairs, in which the defendant fraudulently omitted to disclose all bank accounts he had maintained within two years immediately preceding the filing of the bankruptcy petition, property held by third persons in which he had an interest, including two Rembrandt paintings, and the fact that he had previously filed bankruptcy within the past six years.
All in violation of 18 U.S.C. § 152(3).
[cited in USAM 9-41.001]