451

F: Sworn Statement of Movant—Form DOJ-466

RFPA Form DOJ-466 -- Sworn Statement of Movant IN THE UNITED STATES DISTRICT COURT FOR THE _____________________ DISTRICT OF_______________________ (Name of District) (State in which Court is located) _______________________ (Customer's Name) Movant v. Miscellaneous No. UNITED STATES DEPARTMENT OF JUSTICE SWORN STATEMENT OF MOVANT Respondent I, _______________________________, (am presently/was previously) (Customer's Name) (Indicate One) a customer of ______________________________________________________ (Name of Financial Institution) and I am the customer whose records are being requested by the Government. The financial records sought by ____________________________________ (Name of Government Agency) are not relevant to the legitimate law enforcement inquiry stated in the Customer Notice that was sent to me because ____________________________________________________________ ____________________________________________________________________, or should not be disclosed because there has not been substantial compliance with the Right To Financial Privacy Act of 1978 in that ____________________________________________________________________ ____________________________________________________________________, or should not be disclosed on the following other legal basis _________________________________ ____________________________________________________________________. I declare under penalty of perjury that the foregoing is true and correct. _______________ ____, 19____________________________ (Date) (Customer's Signature) § 1110 of the Right to Financial FORM DOJ-466 Privacy Act, 12 U.S.C. § 3410