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26 U.S.C. § 7203
Individual - Information Return
Failure to File

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE ____________ DISTRICT OF ____________

UNITED STATES OF AMERICA v. _______________________

) ) ) ) )

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

The United States Attorney charges:

That during the calendar year 19___, the defendant, [Defendant's Name], made payments of [E.g., Rent, Salaries, Wages, Premiums, Annuities, Compensations, Remunerations, Gains, Profits, or Income], to the persons and in the amounts following:

NAME	ADDRESS	AMOUNT
______________	______________	______________
______________	______________	______________
______________	______________	______________

That by reason of such payments, [Defendant's Name] was required by law to make a return on United States Treasury Department Internal Revenue Service Form 1096 on or before the 28th day of February, 19___, to the Director, Internal Revenue Service Center, at [City], [State],¹ in the __________ District of ____________, setting forth the number of returns on United States Treasury Department Internal Revenue Service Form(s) 1099 attached thereto; 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 Center at said time and place, or to any other proper officer of the United States.

In violation of Title 26, United States Code, Section 7203.

_________________________________
United States Attorney

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NOTES

1. Use Internal Revenue Service Center where Form 1096 was required to be filed. See Instructions for Forms 1096. Treas. Reg. 1.6041-6 (26 C.F.R.).

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Uploaded April 1998

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