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26 U.S.C. § 7206(1)
Individual - 26 U.S.C. 6050I
Returns Relating to Cash Received in Trade or Business
Failing False Return

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., § 7206(1)

The grand jury charges:

That on or about the _______ day of _________________, 19___, in the _________________ District of ______________________, [Defendant's Name], a resident of [City], [State], did willfully make and subscribe a return on United States Treasury Department Internal Revenue Service Form 8300, for a cash payment in excess of $10,000 received on [Date], which was verified by a written declaration that it was made under the penalties of perjury and was filed with the Internal Revenue Service, which said return on United States Treasury Department Internal Revenue Service Form 8300 he [she] did not believe to be true and correct as to every material matter in that the said return [State Each False Item Reported, e.g., Name of Payor, Cash Received in the Amount of $________], whereas, as he [she] then and there well knew and believed, he [she] received [State Each False Item But Not Amount, e.g., Name of Payor, Cash Received in Excess of Amount Reported], in addition to that heretofore stated.

In violation of Title 26, United States Code, Sections 6050I and 7206(1), and 26 Code of Federal Regulations, Section 1.6050I-1.

A True Bill.

_________________________
Foreperson

_________________________
United States Attorney


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