Pt. 504, App. E
Appendix E to Part 504—Customer Notice of Formal Written Request—Sample Format
1500 N. Main Street, Washington, DC 20314.
Dear Mr./Ms. __: Information or records concerning your transactions held by the financial institution named in the attached request are being sought by the (agency/department) in accordance with the Right to Financial Privacy Act of 1978, section 3401 et seq., Title 12, United States Code, and Army Regulation 190-6, for the following purpose(s):
(List the purpose(s))
If you desire that such records or information not be made available, you must do the following:
a. Fill out the accompanying motion paper and sworn statement or write one of your own—
(1) Stating that you are the customer whose records are being requested by the Government.
(2) Giving the reasons you believe that the records are not relevant or any other legal basis for objecting to the release of the records.
b. 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)
c. Mail or deliver a copy of your motion and statement to the requesting authority: (give title and address).
d. Be prepared to come to court and present your position in further detail.
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) (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 if such transfer is made.
3 Enclosures (see para __)