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RFPA
Form Q-3 -- Affidavit
IN TME UNITED STATES DISTRICT COURT
FOR THE _______ DISTRICT OF _______
IN RE: GRAND JURY SUBPOENAS
DUCES TECUM, MISC. NO. _____________
(INSERT DATE OF SUBPOENA)
SAMPLE
AFFIDAVIT
I HEREBY CERTIFY that on this ____ day of ________, l981, before me,
a
Notary Public in and for the City of (insert name of city and state),
personally
appeared (name of affiant) and made oath in due form of law as follows:
- The affiant is a Criminal Investigator employed by the (insert
name
of agency) and assigned the responsibility of assisting the (insert month
and
year) Term ______ Grand Jury in its investigation of certain offenses
against the
Federal criminal laws involving (insert brief description of nature of
investigation).
- With the assistance of the affiant, the United States Attorney, and
Assistant United States Attorney (insert name of Assistant U.S. Attorney),
the
Grand Jury is continuing an investigation begun by the (insert name of
agency)
into allegations that (describe allegations under investigation by the grand
jury).
- Notification of service of the subpoena duces tecum upon the (insert
name
of bank) will directly alert several persons, including (insert name), to
the
existence, and perhaps to the nature, of the Grand Jury's investigation.
Such
notification (will seriously jeopardize the undercover investigative efforts
presently conducted by the (insert name of agency) and) will impair the
ability
of the Grand Jury to obtain testimony and other evidence concerning the
violations of federal law now under investigation. Consequently, the
government
has sought the issuance of an Order, under the terms of the Right to
Financial
Privacy Act, Title 12, United States Code, Section 3401, et seq., the
Court's
inherent poweWrits Act, Title 28, United States Code, Section 1651, to delay
for
90 days the notification of any customer of the financial institution of the
fact
of service of the subpoena; of the nature of the documents subpoenaed; and
of
the fact that such records have been produced in compliance with the terms
of the
subpoena.
- The Government will move the Court to vacate the Order as
expeditiously as
practicable to limit as much as possible the potential infringement upon the
rights of the Bank to speak freely about the subpoena with which it has been
served.
_________________________
(INSERT NAME OF AFFIANT)
_________________________
NOTARY PUBLIC
MY COMMISSION EXPIRES: _________________________
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