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18 U.S.C. § 287
False Claim for Refund1IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ____________ DISTRICT OF ____________
UNITED STATES OF AMERICA
v.
_______________________
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)
)
)
)No. __________________
18 U.S.C., § 287The grand jury charges:
That on or about the _____ day of __________, 19___, in the __________ District of __________, [insert Defendant's Name], a resident of _______________, _______________, made and presented to the United States Treasury Department a claim against the United States for payment, which he [she] knew to be false, fictitious, or fraudulent, by preparing and causing to be prepared,2 a U.S. Individual Income Tax Return, Form 1040,3 which was presented to the United States Treasury Department, through the Internal Revenue Service, wherein he [she] claimed a refund of taxes in the amount of $ __________, knowing such claim to be false, fictitious, or fraudulent.
In violation of Title 18, United States Code, Section 287.
A True Bill.
_________________________
Foreperson_________________________
United States Attorney
NOTES1. This form is for use with false paper returns.
2. If venue is to be placed in the district of filing, modify this form in accordance with language at Forms - 3 and related footnote 2. If venue is based on mailing, substitute "by mailing and causing to be mailed".
3. The appropriate IRS form should be designated here -- e.g., U.S. Corporation Income Tax Return, Form 1120.
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Uploaded April 1998
