Pt. 275, App. L
Appendix L to Part 275—Format for Customer Notice for Administrative or Judicial Subpoena or for a Formal Written Request
Mr./Ms. XXXXX X. XXXX
1500 N. Main Street
Anytown, VA 00000-0000
Dear Mr./Ms. XXXX:
Information or records concerning your transactions held by the financial institution named in the attached [administrative subpoena or summons] [judicial subpoena] [request] are being sought by the [Agency/ Department] in accordance with the Right to Financial Privacy Act of 1978, Title 12, United States Code, Section 3401 et seq., and [Component's implementing document], for the following purpose(s):
[List the purpose(s)]
If you desire that such records or information not be made available, you must:
1. Fill out the accompanying motion paper and sworn statement or write one of your own, stating that you are the customer whose records are being requested by the Government and either giving the reasons you believe that the records are not relevant to the legitimate law enforcement inquiry stated in this notice or any other legal basis for objecting to the release of the records.
2. File the motion and statement by mailing or delivering them to the clerk of any one of the following United States District Courts:
[List applicable courts]
3. Serve the Government authority requesting the records by mailing or delivering a copy of your motion and statement to: [Give title and address].
4. Be prepared to come to court and present your position in further detail.
5. You do not need to have a lawyer, although you may wish to employ one to represent you and protect your rights.
If you do not follow the above procedures, upon the expiration of 10 days from the date of personal service or 14 days from the date of mailing of this notice, the records or information requested therein may be made available. These records may be transferred to other Government authorities for legitimate law enforcement inquiries, in which event you will be notified after the transfer.
[Name and title of official]
1. Copy of request
2. Motion papers
3. Sworn statement