On or about ______ , in the ________ District of _______, JOHN DOE,
defendant herein, devised a scheme and artifice to defraud Sears Roebuck Co.
of its right to collect debts owed to Sears Roebuck Co. by falsely claiming
he was in bankruptcy and that Sears Roebuck Co. could not garnish his wages,
and for the purpose of executing such scheme and artifice, delivered to
Sears Roebuck Co. credit office a notice that said JOHN DOE had filed a
Petition in Bankruptcy and was entitled to the protection of the automatic
stay, when in truth and in fact, as JOHN DOE well knew, he had not filed a
petition in bankruptcy and had not been granted an automatic stay under the
Bankruptcy Code.