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26 U.S.C. § 7203
Individual - 26 U.S.C. § 6050I
Returns Relating to Cash Received in Trade or Business
Failure to File

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE ____________ DISTRICT OF ____________

UNITED STATES OF AMERICA

    v.

_______________________

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)
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No. __________________
26 U.S.C., § 7203

The grand jury charges:

That on or about the _____ day of _________________, 19___, in the __________________ District of __________________, [Defendant's Name], whose principal place of business was in [City], [State], received a payment in a trade or business, to wit, [identify trade or business], in excess of $10,000 United States currency, to wit, [amount of currency].

That by reason of such payment, [Defendant's Name], was required by law to make a return on United States Treasury Department Internal Revenue Service Form 8300 on or before the _____day of _____________, 19___, to the Director, Internal Revenue Service, _____________ Division, at [City], [State], in the _____________ District of _____________, or to the Director, Internal Revenue Service Center, at [City], [State], or other proper officer of the United States, stating specifically the items of identify of the individual from whom the cash was received, the person on whose behalf this transaction was conducted, the description of transaction and method of payment, and the business reporting this transaction on United States Treasury Department Internal Revenue Service Form 8300; that well-knowing and believing all of the foregoing, [Defendant's Name] did willfully fail to make said return to said Director of the Internal Revenue Service at said time and place, or to any other proper officer of the United States.

In violation of Title 26, United States Code, Sections 6050I and 7203, and Treas. Reg. §1.6050I-1 (26 C.F.R.)

A True Bill.

_________________________
Foreperson

_________________________
United States Attorney


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