______________ DISTRICT OF __________________

UNITED STATES OF AMERICA,

Civil No.

Petitioner,

v. PETITION TO ENFORCE INTERNAL

REVENUE SERVICE SUMMONS

Respondent. Date:

Time:

______________________________

1. This proceeding is brought at the request of the Chief Counsel, Internal Revenue Service, a delegate of the Secretary of the Treasury, and at the direction of the Attorney General of the United States.

2. Jurisdiction is conferred upon this Court pursuant to 26 U.S.C. §�(a)&(b) and 7604(a) and 28 U.S.C. §� and 1345.

3. Venue is proper in the _________________ District of _________________________ as the respondent hereinafter named resides in or may be found within the boundaries of this district.

4. At all relevant times _______________________ was a _______________ Agent of the Internal Revenue Service, employed in the ________________________ Division of the Office of the District Director in __________________ , ______________________________, and is authorized to issue Internal Revenue Service summonses pursuant to the authority contained in 26 U.S.C. �, Treasury Regulation 𨶅.7602-1 (26 C.F.R.), and IRS Delegation Order No. 4.

5. The respondent's residence is located_______________________________________, which is within the jurisdiction of this Court.

6. Agent _________________ is conducting an investigation to ascertain the correctness of the ______________________ Income Tax Return (Form _______) of ___________________________________________________ for the _________ tax year (See Declaration of ________________ Agent _____________________ (hereinafter "_____________ Decl."), ܞ).

7. Respondent _______________________ has personal knowledge of, and is in possession and control of information and documents relating to, the above-described investigation (____________ Decl., ܠ ).

8. On _____________________________ Agent _________________ issued a Form 2039 Internal Revenue Service summons (hereinafter "the summons") to the respondent, in his capacity _______________________________________, relating to the above-described investigation. The summons directed the respondent to appear before Agent _____________, or his delegate, on ______________________________________ at ___________ a.m., at, ______________________________________________________________________________ ______________________________ to give testimony and provide documents as stated in the summons and in Exhibit A attached thereto (____Decl., ܟ).

9. Respondent is the ______________ of ________________________________________ as is evidenced by his execution, in that capacity, of the entity's _______ income tax return (Form _______) (________Decl., ܠ).

10. _________________________________________ Agent ________________ served the subject summons by handing an attested copy to the respondent at his residence, ____________________________________________, as is evidenced by the Certificate of Service on the reverse side of the summons (__________ Decl., ܡ).

11. [After failing to appear previously, _____________________________, the respondent appeared before Agent _______________ but refused to allow Agent ___________________ to copy any of the documents the respondent brought with him to the appearance. In addition, although he permitted the agent to view certain documents, he refused to permit the inspection of a number of the items described in the summons and refused to respond to certain questions asked of him by Agent ________________. Consequently, the respondent has failed to completely obey the summons as required by law (___________ Decl., ܡ).]

12. The information and documents sought by the summons are not already in the possession of the Internal Revenue Service (_____________ Decl., ܤ).

13. The testimony and documents demanded by the summons are necessary in order to assist the IRS in ascertaining the correctness of the U.S. _______________ Income Tax Return (Form ____________) filed by _______________________________________ for the ________ tax year (__________ Decl., 䜣).

14. All administrative procedures required by the Internal Revenue Code for the proper issuance and service of the summons have been followed (_______________ Decl., ܥ).

15. A Justice Department referral, as defined by 26 U.S.C. �(c)(2), is not in effect with respect to ____________________________________________ or __________________________________ for the period in issue (__________________ Decl., 䜢).
    WHEREFORE, the petitioner respectfully prays as follows:

    1. That the Court enter an order directing the respondent, _________________________________ to show cause, if any, why he should not comply with and obey the aforementioned summons and each requirement thereof;

    2. That the Court enter an order directing the respondent, ________________________________ to show cause, if any, why he should not fully obey the aforementioned summons and each requirement thereof, by ordering the attendance, testimony, and production required and called for by the terms of the summons (limited, however, as described in Agent ___________________ declaration), before __________________ Agent _______________, or any other proper officer or employee of the IRS, at such time and place as may by fixed by _______________ Agent _____________ or any other proper officer or employee of the IRS;

    3. That the Court enter an order directing the respondent, ___________________________________, to show cause, if any, why he should not be required to permit the copying of each of the documents produced;

    4. That the United States recover its costs and attorneys' fees in maintaining this action; and,

    5. That the Court grant such other and further relief as is just and proper.

United States Attorney

____________________________________________

Assistant United States Attorney