IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............ DISTRICT OF ............. UNITED STATES OF AMERICA ) ) v. ) COMPLAINT ) ........................ ) COMPLAINT FOR VIOLATION OF SECTION 7201 1/ INTERNAL REVENUE CODE OF 1954 Before (Magistrate's Name), United States Magistrate, (Judicial District). The undersigned complainant, being duly sworn, states: That he/she is a Special Agent (or Revenue Agent) of the Internal Revenue Service and, in the performance of the duties imposed on him/her by, he/she has conducted an investigation of the Federal income tax liability of (Defendant's Name) of (City), (State), for the calendar year 2/ 19.., by examining the said taxpayer's tax return for the calendar year 2/ 19.., and other years; (e.g., by examination and audit of the said taxpayer's business and financial books and records; by identifying and interviewing third parties with whom the said taxpayer did business; by consulting public and private records reflecting the said taxpayer's income; and/or by interviewing third persons having knowledge of the said taxpayer's financial condition.) 3/ That based on the aforesaid investigation, the complainant has personal knowledge that on or about the ..... day of ...., 19.., at (City), (State) in the ............. District of ..............., (Defendant's Name) did unlawfully and willfully attempt to evade and defeat the income taxes due and owing by him/her 1/ to the United States of America for the calendar year 2/ 19.., by preparing and causing to be prepared, and by signing and causing to be signed in the ................ District of ................, 4/ a false and fraudulent U.S. Individual Income Tax Return, Form 1040, which was filed with the Internal Revenue Service, wherein he/she stated that his/her taxable 5/ (or adjusted gross) income for the calendar year 2/ 19.. was $........, and that the amount of tax due and owing thereon was the sum of $........, when in fact his/her taxable 5/ (or adjusted gross) income for the said calendar year 2/ was the sum of $........, upon which said taxable 5/ (or adjusted gross) income he/she owed to the United States of America an income tax of $............ ..................... 6/ Title of Subscribing Internal Revenue Service Officer Sworn to before me and subscribed in my presence, this ....... day of ..............., 19.. . .................... United States Magistrate ....................

OCTOBER 1985

1/ When drafting complaints for violation of other Sections of the Internal Revenue Code, refer to the appropriate indictment form as a guide. 2/ If fiscal year is involved, substitute "fiscal year ended ............, 19..". 3/ The bracketed descriptions of the kinds of investigation conducted by the subscribing agent may all be used if they correctly reflect the facts. Otherwise, the inapposite description should, of course, be deleted. When appropriate, the description of a different investigative course should be added or substituted based on the facts. See 'Jaben v. United States', 381 U.S. 214 (1965). 4/ If venue is to be placed in the judicial district in which the return was filed, refer to the appropriate language in Form No. 2. If venue is based upon mailing, substitute "by mailing and causing to be mailed". 5/ Forms 1040 for some years do not use the phrase "taxable income" or "tax table income". However, what constitutes taxable income as defined in 26 U.S.C., Sec. 63, is actually computed on the appropriate line of the return. That line may vary and the line on the return showing the amount on which the actual tax was computed should be used. 6/ To be sworn to by an Internal Revenue Service Officer having Knowledge of the facts.

Complaint to Toll Statute of Limitations

FORM NO. 1

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. ................... ) 26 U.S.C., Sec. 7201 ........................ ) 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 attempt to evade and defeat a large part of the income tax due and owing by him/her to the United States of America for the calendar year 1/ 19.., by filing and causing to be filed with the Director, Internal Revenue Service Center, at (City), (State), 2/ a false and fraudulent U.S. Individual Income Tax Return, Form 1040, wherein he/she stated that his/her taxable income 3/ for the calendar year 1/ 19.., was the sum of $........, and that the amount of tax due and owing thereon was the sum of $........, whereas, as he/she then and there well knew and believed, his/her taxable income 3/ for the said calendar year 1/ was the sum of $........, upon which said taxable income 3/ there was owing to the United States of America an income tax of $......... 4/ In violation of Title 26, United States Code, Section 7201. A True Bill. ......................... Foreperson ......................... United States Attorney ......................

OCTOBER 1985

1/ If fiscal year is involved, substitute "fiscal year ended .........., 19..". 2/ When appropriate, substitute "by filing and causing to be filed with the District Director of the Internal Revenue Service for the Internal Revenue District of ..........., at ..............."; or "by filing and causing to be filed with the Representative of the District Director of the Internal Revenue Service for the Internal Revenue District of ............., at .....................". 3/ Forms 1040 for some years do not use the phrase "taxable income" or "tax table income". However, what constitutes taxable income, as defined in 26 U.S.C., Sec. 63, is actually computed on the appropriate line of the return. That line may vary and the line on the return showing the amount on which the actual tax was computed should be used. 4/ If it is determined that unreported income and tax are not to be numerically alleged in the indictment, then substitute "whereas, as he/she then and there well knew and believed, his/her taxable income for the said calendar year was substantially in excess of that heretofore stated and that upon said additional taxable income a substantial additional tax was due and owing to the United States of America". See 'United States v. Buckner', 610 F.2d 570, 573 (9th Cir. 1979), cert. denied, 445 U.S. 961 1980).

Individual (district of filing)

FORM NO. 2

STATUTE: 26 U.S.C. Sec. 7201 - Attempt to Evade - Indictment

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. ................... ) 26 U.S.C., Sec. 7201 ........................ ) 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 attempt to evade and defeat a large part of the income tax due and owing by him/her to the United States of America for the calendar year 1/ 19.., by preparing and causing to be prepared, and by signing and causing to be signed, 2/ a false and fraudulent U.S. Individual Income Tax Return, Form 1040, which was filed with the Internal Revenue Service, wherein he/she stated that his/her taxable income 3/ for said calendar year 1/ was the sum of $........, and that the amount of tax due and owing thereon was the sum of $........, whereas, as he/she then and there well knew and believed, his/her taxable income 3/ for the said calendar year 1/ was the sum of $........, upon which said taxable income 3/ there was owing to the United States of America an income tax of $......... 4/ In violation of Title 26, United States Code, Section 7201. A True Bill. ......................... Foreperson ......................... United States Attorney ........................

OCTOBER 1985

1/ If fiscal year is involved, substitute "fiscal year ended ..........., 19..". 2/ Where venue is based on mailing, substitute "by mailing and causing to be mailed". 3/ Forms 1040 for some years do not use the phrase "taxable income" or "tax table income". However, what constitutes taxable income, as defined in 26 U.S.C., Sec. 63, is actually computed on the appropriate line of the return. That line may vary and the line on the return showing the amount on which the actual tax was computed should be used. 4/ If it is determined that unreported income and tax are not to be numerically alleged in the indictment, then substitute "whereas, as he/she then and there well knew and believed, his/her taxable income for the said calendar year was substantially in excess of that heretofore stated and that upon said additional taxable income a substantial additional tax was due and owing to the United States of America". See 'United States v. Buckner', 610 F.2d 570, 573 (9th Cir. 1979), cert. denied, 445 U.S. 961 (1980).

Individual (district of preparation)

FORM NO. 3

STATUTE: 26 U.S.C. Sec. 7201 - Attempt to Evade - Indictment

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. .................... ) 26 U.S.C., Sec. 7201 ........................ ) The grand jury charges: That on or about the ...... day of .........., 19.., in the .......... District of ............., (Defendant's Name), a resident of (City), (State), who during the calendar year 1/ 19.. was married, did willfully attempt to evade and defeat a large part of the income tax due and owing by him/her and his/her spouse to the United States of America for the calendar year 1/ 19.., by filing and causing to be filed with the Director, Internal Revenue Service Center, at (City), (State), 2/ a false and fraudulent joint U.S. Individual Income Tax Return, Form 1040, on behalf of himself/herself and his/her spouse, wherein it was stated that their joint taxable income 3/ for said calendar year 1/ was the sum of $........., and that the amount of tax due and owing thereon was the sum of $........., whereas, as he/she then and there well knew and believed, their joint taxable income 3/ for the said calendar year 1/ was the sum of $........., upon which said joint taxable income 3/ there was owing to the United States of America an income tax of $.......... 4/ In violation of Title 26, United States Code, Section 7201. A True Bill. ......................... Foreperson ......................... United States Attorney ......................

OCTOBER 1985

1/ If fiscal year is involved, substitute "fiscal year ended .........., 19..". 2/ When appropriate, substitute "with the District Director of the Internal Revenue Service for the Internal Revenue District of .................., at ...................."; or "with the Representative of the District Director of the Internal Revenue Service for the Internal Revenue District of ................, at ...................". 3/ Forms 1040 for some years do not use the phrase "taxable income" or "tax table income". However, what constitutes taxable income, as defined in 26 U.S.C., Sec. 63, is actually computed on the appropriate line of the return. That line may vary and the line on the return showing the amount on which the actual tax was computed should be used. 4/ If it is determined that unreported income and tax are not to be numerically alleged in the indictment, then substitute "whereas, as he/she then and there well knew and believed, their joint taxable income for the said calendar year was substantially in excess of that heretofore stated and that upon said additional joint taxable income a substantial additional tax was due and owing to the United States of America". See 'United States v. Buckner, 610 F.2d 570, 573 (9th Cir. 1979), cert. denied, 445 U.S. 961 (1980).

Individual (joint return - district of filing)

FORM NO. 4

STATUTE: 26 U.S.C. Sec. 7201 - Attempt to Evade - Indictment

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. .................... ) 26 U.S.C., Sec. 7201 ........................ ) The grand jury charges: That on or about the ...... day of ............, 19.., in the ........... District of ................, (Defendant's Name), a resident of (City), (State), who during the calendar year 1/ 19.. was married, did willfully attempt to evade and defeat a large part of the income tax due and owing by him/her and his/her spouse to the United States of America for the calendar year 1/ 19.., by preparing and causing to be prepared, and by signing and causing to be signed, 2/ a false and fraudulent joint U.S. Individual Income Tax Return, Form 1040, on behalf of himself/herself and his/her spouse, which was filed with the Internal Revenue Service, wherein it was stated that their joint taxable income 3/ for said calendar year 1/ was the sum of $........., and that the amount of tax due and owing thereon was the sum of $........., whereas, as he/she then and there well knew and believed, their joint taxable income 3/ for the said calendar year 1/ was the sum of $........., upon which said joint taxable income 3/ there was owing to the United States of America an income tax of $.......... 4/ In violation of Title 26, United States Code, Section 7201. A True Bill. ......................... Foreperson ......................... United States Attorney .......................

OCTOBER 1985

1/ If fiscal year is involved, substitute "fiscal year ended ............, 19..". 2/ If venue is based on mailing, substitute "by mailing and causing to be mailed". 3/ Forms 1040 for some years do not use the phrase "taxable income" or "tax table income". However, what constitutes taxable income, as defined in 26 U.S.C., Sec. 63, is actually computed on the appropriate line of the return. That line may vary and the line on the return showing the amount on which the actual tax was computed should be used. 4/ If it is determined that unreported income and tax are not to be numerically alleged in the indictment, then substitute "whereas, as he/she then and there well knew and believed, their joint taxable income for the said calendar year was substantially in excess of that heretofore stated and that upon said additional joint taxable income a substantial additional tax was due and owing to the United States of America." See 'United States v. Buckner', 610 F.2d 570, 573 (9th Cir. 1979), cert. denied, 445 U.S. 961 (1980).

Individual (joint return - district of preparation)

FORM NO. 5

STATUTE: 26 U.S.C. Sec. 7201 - Attempt to Evade - Indictment

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. .................... ) 26 U.S.C., Sec. 7201 ........................ ) 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 attempt to evade and defeat a large part of the income tax due and owing by him/her to the United States of America for the calendar year 1/ 19.., by preparing and causing to be prepared, and by signing and causing to be signed, 2/ a false and fraudulent U.S. Individual Income Tax Return, Form 1040, which was filed with the Internal Revenue Service, wherein he/she stated that his/her taxable income 3/ for said calendar year, 1/ computed on the community property basis, was the sum of $........., and that the amount of tax due and owing thereon was the sum of $........., whereas, as he/she then and there well knew and believed, his/her taxable income 3/ for the said calendar year 1/, computed on the community property basis, was the sum of $........., upon which said taxable income 3/ there was owing to the United States of America an income tax of $.......... 4/ In violation of Title 26, United States Code, Section 7201. A True Bill. ......................... Foreperson ......................... United States Attorney ......................

OCTOBER 1985

1/ If fiscal year is involved, substitute "fiscal year ended ............., 19..". 2/ If venue is to be placed in the judicial district in which the return was filed, modify this form in accordance with Form No. 2. If venue is based on mailing, substitute "by mailing and causing to be mailed". 3/ Forms 1040 for some years do not use the phrase "taxable income" or "tax table income". However, what constitutes taxable income, as defined in 26 U.S.C., Sec. 63, is actually computed on the appropriate line of the return. That line may vary and the line on the return showing the amount on which the actual tax was computed should be used. 4/ If it is determined that unreported income and tax are not to be numerically alleged in the indictment, then substitute "whereas, as he/she then and there well knew and believed, his/her taxable income for the said calendar year, computed on the community property basis, was substantially in excess of that heretofore stated and that upon said additional taxable income a substantial additional tax was due and owing to the United States of America". See 'United States v. Buckner', 610 F.2d 570, 573 (9th Cir. 1979), cert. denied, 445 U.S. 961 (1980).

Individual (community property return)

FORM NO. 6

STATUTE: 26 U.S.C. Sec. 7201 - Attempt to Evade - Indictment

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 7201 ........................ ) The grand jury charges: That on or about the ...... day of ............, 19.., in the .......... District of ..............., (Defendant's Name), a resident of (City), (State), who during the calendar year 1/ 19.. was married to (Name of Spouse), did willfully attempt to evade and defeat a large part of the income tax due and owing by the said (Name of Spouse) to the United States of America for the calendar year 1/ 19.., by preparing and causing to be prepared, and by signing and causing to be signed, 2/ a false and fraudulent U.S. Individual Income Tax Return, Form 1040, which was filed with the Internal Revenue Service for and on behalf of the said (Name of Spouse), in which it was stated that his/her taxable income 3/ for said calendar year 1/, computed on the community property basis, was the sum of $........., and that the amount of tax due and owing thereon was the sum of $........., whereas, as (Defendant's Name) then and there well knew and believed, the taxable income 3/ of (Name of Spouse) for the said calendar year 1/, computed on the community property basis, was the sum of $........., upon which said taxable income 3/ there was owing to the United States of America an income tax of $.......... 4/ In violation of Title 26, United States Code, Section 7201. A True Bill. ......................... Foreperson ......................... United States Attorney ........................

OCTOBER 1985

1/ If fiscal year is involved, substitute "fiscal year ended ..........., 19..". 2/ If venue is to be placed in the judicial district in which the return was filed, modify this form in accordance with Form No. 2. If venue is based on mailing, substitute "by mailing and causing to be mailed". 3/ Forms 1040 for some years do not use the phrase "taxable income" or "tax table income". However, what constitutes taxable income, as defined in 26 U.S.C., Sec. 63, is actually computed on the appropriate line of the return. That line may vary and the line on the return showing the amount on which the actual tax was computed should be used. 4/ If it is determined that unreported income and tax are not to be numerically alleged in the indictment, then substitute "whereas, as he/she then and there well knew and believed, the taxable income of (Name of Spouse) for the said calendar year, computed on the community property basis, was substantially in excess of that heretofore stated and that upon said additional taxable income a substantial additional tax was due and owing to the United States of America". See 'United States v. Buckner', 610 F.2d 570, 573 (9th Cir. 1979), cert. denied, 445 U.S. 961 (1980).

Individual (community property return of spouse)

FORM NO. 7

STATUTE: 26 U.S.C. Sec. 7201 - Attempt to Evade - Indictment

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 7201 ........................ ) 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 attempt to evade and defeat a large part of the income tax due and owing by him/her to the United States of America for the calendar year 1/ 19.., by (Describe Act or Acts, e.g., Filing False Financial Statement, or Making False Statements or Representations to Employees of the Internal Revenue Service, etc. See 'Spies v. United States', 317 U.S. 492 (1943)), for the purpose of concealing additional unreported taxable income received by (Defendant's Name) during the said calendar year 1/, on which said unreported taxable income, as he/she then and there well knew and believed, there was due and owing to the United States of America an income tax of $......... (Insert Amount of Tax Deficiency, Not Total Tax). 2/ In violation of Title 26, United States Code, Section 7201. A True Bill. ......................... Foreperson ......................... United States Attorney .......................

OCTOBER 1985

1/ If fiscal year is involved, substitute "fiscal year ended ............., 19..". 2/ If it is determined that unreported tax is not to be numerically alleged in the indictment, then delete "an income tax of $........." and substitute "a substantial additional tax". See 'United States v. Buckner', 610 F.2d 570, 573 (9th Cir. 1979), cert. denied, 445 U.S. 961 (1980).

Individual (acts subsequent to filing - 'Beacon Brass')

FORM NO. 8

STATUTE: 26 U.S.C. Sec. 7201 - Attempt to Evade - Indictment

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 7201 ) ..................... ) The grand jury charges: That during the calendar year 1/ 19.., (Defendant's Name), a resident of (City), (State), had and received taxable income 2/ in the sum of $.........; that upon said taxable income 2/ there was owing to the United States of America an income tax of $.........; that well-knowing and believing the foregoing facts, (Defendant's Name), on or about April 15, 19.., 3/ in the ............ District of ................., did willfully attempt to evade and defeat the said income tax due and owing by him/her to the United States of America for said calendar year 1/ by failing to make an income tax return on or before April 15, 19.., 3/ as required by law, to any proper officer of the Internal Revenue Service, by failing to pay to the Internal Revenue Service said income tax, and by (Set Forth the Affirmative Act(s) of Evasion, Such as Concealing and Attempting to Conceal From All Proper Officers of the United States of America His/Her True and Correct Income. See 'Spies v. United States', 317 U.S. 492, 499 (1943)). In violation of Title 26, United States Code, Section 7201. A True Bill. ......................... Foreperson ......................... United States Attorney .......................

OCTOBER 1985

1/ If fiscal year is involved, substitute "fiscal year ended ..........., 19..". Fiscal year individual returns must be filed on or before the 15th day of the fourth month after the end of the fiscal year. 26 U.S.C., Sec. 6072(a). 2/ For definition of taxable income, see 26 U.S.C., Sec. 63. Note also 26 U.S.C., Secs. 61, et seq. 3/ Note that if April 15th fell on a Saturday, Sunday, or legal holiday, the filing date to charge in the indictment would be the next succeeding day that was not a Saturday, Sunday, or legal holiday. Note also that the date the return was due should include any authorized extensions of time for filing. 26 U.S.C., Sec. 7503.

Individual (no return - 'Spies' evasion)

FORM NO. 9

STATUTE: 26 U.S.C. Sec. 7201 - Attempt to Evade - Indictment

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 7201 ........................ ) The grand jury charges: That on or about the ...... day of ..........., 19.., 1/ in the ........... District of .............., (Defendant's Name), a resident of (City), (State), did willfully attempt to evade and defeat the payment of a large part of the income tax due and owing by him/her to the United States of America for the calendar year 2/ 19.., in the amount of $........., by (Set Forth the Affirmative Acts Constituting the Willful Attempt, Such as the Following: Concealing and Attempting to Conceal From the Internal Revenue Service the Nature and Extent of His/Her Assets and the Location Thereof; Making False Statements to Agents of the Internal Revenue Service; Placing Funds and Property in the Names of Nominees; Placing Funds and Property Beyond the Reach of Service of Process; etc.). In violation of Title 26, United States Code, Section 7201. A True Bill. ......................... Foreperson ......................... United States Attorney .......................

OCTOBER 1985

1/ The "attempt" may consist of a course of conduct. If so, substitute "on or about the ...... day of ................., 19.., and continuing to ..............". 2/ If fiscal year is involved, substitute "fiscal year ended ............, 19.."; if more than one year's tax is involved, substitute "for the years ........... through ..............".

Individual (evasion of payment)

FORM NO. 10

STATUTE: 26 U.S.C. Sec. 7201

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............. UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 7201 ........................ ) The grand jury charges: That on or about the ...... day of ..........., 19.., in the ........... District of ................., (Defendant's Name, 1/ who was the (Position Held in Corp.) of (Name of Corporation), a corporation, did willfully attempt to evade and defeat a large part of the income tax due and owing by the said corporation to the United States of America for the calendar year 2/ 19.., by preparing and causing to be prepared, and by signing and causing to be signed, 3/ a false and fraudulent U.S. Corporation Income Tax Return, Form 1120, which was filed with the Internal Revenue Service on behalf of said corporation, wherein it was reported that the taxable income of said corporation for the said calendar year 2/ was the sum of $........, and that the total amount of tax due and owing thereon was the sum of $........., whereas, as he/she/it then and there well knew and believed, the taxable income of (Name of Corporation) for the calendar year 2/ 19.., was the sum of $........., upon which taxable income there was due and owing to the United States of America a total tax of $.......... 4/ In violation of Title 26, United States Code, Section 7201. A True Bill. ......................... Foreperson ......................... United States Attorney .......................

OCTOBER 1985

1/ If the corporation is named as the defendant, substitute the name of the corporation. 2/ If fiscal year is involved, substitute "fiscal year ended ............., 19..". 3/ If venue is to be placed in the judicial district in which the return was filed, modify this form in accordance with Form No. 2. If venue is based on mailing, substitute "by mailing and causing to be mailed". 4/ If it is determined that unreported income and tax are not to be numerically alleged in the indictment, then substitute "whereas, as he/she/it then and there well knew and believed, the taxable income of the said corporation for the said calendar year was substantially in excess of that heretofore stated and that upon said additional taxable income a substantial additional tax was due and owing to the United States of America". See 'United States v. Buckner', 610 F.2d 570, 573 (9th Cir. 1979), cert. denied, 445 U.S. 961 (1980).

Corporation (false return)

FORM NO. 11

STATUTE: 26 U.S.C. Sec. 7201 - Attempt to Evade - Indictment

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............ DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 7201 ........................ ) The grand jury charges: That on or about the ...... day of ..........., 19.., in the ........... District of ................, (Defendant's Name), 1/ who was the (Position Held in Corp.) of (Name of Corporation), a corporation, did willfully attempt to evade and defeat a large part of the income tax due and owing by the said corporation to the United States of America for the calendar year 2/ 19.., by (Describe Act or Acts; e.g., Filing False Financial Statement, Making False Statements and Representations to Employees of the Internal Revenue Service, etc. See 'Spies v. United States', 317 U.S. 492 (1943)), for the purpose of concealing additional unreported taxable income received by said unreported taxable income, as he/she/it then and there well knew and believed, there was due and owing to the United States of America an income tax of $......... (Insert Amount of Corporation's Tax Deficiency, Not Total Tax). 3/ In violation of Title 26, United States Code, Section 7201. A True Bill. .................... .... Foreperson ......................... United States Attorney .......................

OCTOBER 1985

1/ If the corporation is named as the defendant, substitute the name of the corporation. 2/ If fiscal year is involved, substitute "fiscal year ended ............, 19..". 3/ If it is determined that unreported tax is not to be numerically alleged in the indictment, then delete "an income tax of $.........", and substitute "a substantial additional tax". See 'United States v. Buckner', 610 F.2d 570, 573 (9th Cir. 1979), cert. denied, 445 U.S. 961 (1980).

Corporation (acts subsequent to filing - 'Beacon Brass')

FORM NO. 12

STATUTE: 26 U.S.C. Sec. 7201 - Attempt to Evade - Indictment

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 7201 ........................ ) The grand jury charges: That on or about the ...... day of ..........., 19.., in the ........... District of ................, (Defendant's Name), a resident of (City), (State), who conducted a business 1/ as a (Sole Proprietorship or Partnership) under the name and style of ............., with its principal place of business in (City), (State), did willfully attempt to evade and defeat a large part of the federal income taxes withheld from wages and Federal Insurance Contributions Act taxes due and owing to he United States of America for the quarter ending ..........., 19.., by preparing and and causing to be prepared, and by signing and causing to be signed, 2/ a false and fraudulent Employer's Quarterly Federal Tax Return, Form 941, which was filed with the Internal Revenue Service, wherein it was stated that the total wages subject to withholding paid to employees by (Name of Business) for the said quarter was the sum of $........., and that the total amount of federal income tax withheld and social security taxes due and owing thereon was the sum of $........., whereas, as he/she/it then and there well knew and believed, the total wages subject to withholding paid to employees for said quarter was the sum of $........., upon which wages there were due and owing to the United States of America federal income taxes withheld from wages and social security taxes in the total amount of $.......... In violation of Title 26, United States Code, Section 7201. A True Bill. ......................... Foreperson ......................... United States Attorney .......................

OCTOBER 1985

1/ If employer is a corporation, refer to Form No. 11 as a guide in charging appropriate corporate officials with attempting to evade and defeat taxes due from corporation. 2/ If venue is to be placed in judicial district in which the return was filed, modify this form in accordance with Form No. 2. If venue is based on mailing, substitute "by mailing and causing to be mailed".

Withholding and F.I.C.A. Taxes (Employer's Quarterly Return)

FORM NO. 13

STATUTE: 26 U.S.C. Sec. 7201 - Attempt to Evade - Indictment

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............... DISTRICT OF .......... UNITED STATES OF AMERICA ) ) v. ) No. ............. ) 26 U.S.C., Sec. 7201 ........................ ) The grand jury charges: That on or about the ...... day of ............, 19.., in the ........... District of ..............., (Defendant's Name), 1/ a resident of (City), (State), who conducted a retail 2/ business as a (Sole Proprietorship or Partnership) under the name and style of ....................., with its principal place of business in (City), (State), did willfully attempt to evade and defeat a large part of the retail dealer's 3/ excise tax on (Article), imposed by Section ............. of the Internal Revenue Code (Title 26), due and owing to the United States of America for the quarter ending 4/ ..........., 19.., by preparing and causing to be prepared, and by signing and causing to be signed, 5/ a false and fraudulent Quarterly Federal Excise Tax Return, 6/ which was filed with the Internal Revenue Service on behalf of said retail 2/ business, wherein it was stated that the excise tax due and owing to the United States of America by reason of the retail 2/ sale of (Article) for said quarter 4/ was the sum of $........., whereas, as he/she/it then and there well knew and believed, there was due and owing to the United States of America for the said quarter, 4/ retail dealer's 3/ excise tax in the sum of $.......... In violation of Title 26, United States Code, Section 7201. A True Bill. ......................... Foreperson ......................... United States Attorney .......................

OCTOBER 1985

1/ If a corporation is named as the defendant, substitute the name of the corporation. 2/ Designate appropriate business, e.g., manufacturing. 3/ For other excise taxes, see 26 U.S.C., Secs. 4041, et seq. 4/ Designate appropriate period. 5/ If venue is to be placed in judicial district in which the return was filed, modify this form in accordance with Form No. 2. If venue is based on mailing, substitute "by mailing and causing to be mailed". 6/ Designate appropriate I.R.S. form.

Excise Tax (Quarterly Return

FORM NO. 14

STATUTE: 26 U.S.C. Sec. 7201 - Attempt to Evade - Indictment

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 7202 ........................ ) The grand jury charges: That on or about the ...... day of ..........., 19.., in the ............ District of ................, (Defendant's Name), a resident of (City), (State), who conducted a business as a sole proprietorship 1/ under the name and style of .................., with its principal place of business in (City), (State), and who, during the first quarter 2/ of the year 19.., ending ..........., 19.., deducted and collected from the total taxable wages of his/her employees federal income taxes and Federal Insurance Contributions Act taxes in the sum of $........., did willfully fail to truthfully account for and pay over to the Internal Revenue Service said federal income taxes withheld and Federal Insurance Contributions Act taxes due and owing to the United States of America for the said quarter ending ..............., 19... In violation of Title 26, United States Code, Section 7202. A True Bill. ......................... Foreperson ......................... United States Attorney .......................

OCTOBER 1985

1/ If taxpayer is a corporation, refer to Form No. 11 as a guide in charging appropriate corporate officials with failure to account for and pay over withholding and F.I.C.A. (Social Security) taxes due from the corporation. 2/ Designate appropriate quarter.

Failure to Account For and Pay Over Withholding and F.I.C.A. Taxes

FORM NO. 15

STATUTE: 26 U.S.C. Sec. 7202 - Indictment

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE .............. DISTRICT OF ........... UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 7203 ........................ ) The United States Attorney charges: That during the calendar year 1/ 19.., (Defendant's Name), who was a resident of (City), (State), 2/ had and received gross income of $.........; 3/ that by reason of such gross income he/she was required by law, following the close of the calendar year 1/ 19.., and on or before April 15, 19.., 4/ to make an income tax return to 5/ the District Director of the Internal Revenue Service for the Internal Revenue District of ............, at ............, 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 his/her gross income and any deductions and credits to which he/she was entitled; that well-knowing and believing all of the foregoing, he/she did willfully fail to make an income tax return to said District

Director of the Internal Revenue Service, to said Director of the

Internal Revenue Service Center, or to any other proper officer of the United States. In violation of Title 26, United States Code, Section 7203. ......................... United States Attorney .......................

OCTOBER 1985

1/ If fiscal year is involved, substitute "fiscal year ended ........, 19..". Fiscal year individual returns must be filed on or before the 15th day of the fourth month after the end of the fiscal year. 26 U.S.C., Sec. 6072(a). 2/ If venue is based on defendant's principal place of business, substitute for residence, "whose principal place of business was in (City), (State),". 3/ If the amount of gross income is not to be alleged, substitute "had and received gross income in excess of $......... (minimum filing requirement)." For definition of gross income, see 26 U.S.C., Sec. 61. 4/ If April 15th fell on a Saturday, Sunday, or legal holiday, the appropriate date in the information would be the next succeeding day that was not a Saturday, Sunday, or legal holiday. Note that the date the return was due should include any authorized extensions of time for filing. 26 U.S.C., Sec. 7503. 5/ If the District Director is located in a judicial district other than the judicial district of the defendant's residence or place of business, and venue is to be placed in the judicial district of the defendant's residence or place of business, then insert "the Representative of" and be sure that the location specified in the information, i.e., "at ..............", is the location of the representative -- the field office, and not the main office of the District Director.

Failure to File Individual Return (district of District Director, Hand-Carried Return)

FORM NO. 16

STATUTE: 26 U.S.C. Sec. 7203 - Information

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ........... DISTRICT OF ............. UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 7203 ........................ ) The United States Attorney charges: That during the calendar year 1/ 19.., (Defendant's Name), who was a resident of (City), (State), 2/ had and received gross income of $.........; 3/ that by reason of such gross income he/she was required by law, following the close of the calendar year 1/ 19.., and on or before April 15, 19.., 4/ to make an income tax return to the Director, Internal Revenue Service Center, at (City), (State), in the ............ District of ..............., or to the District Director of the Internal Revenue Service for the Internal Revenue District of ..........., at ..............., or other proper officer of the United States, stating specifically the items of his/her gross income and any deductions and credits to which he/she was entitled; that well-knowing and believing all of the foregoing, he/she did willfully fail to make an income tax return to said Director of the Internal Revenue Service Center, to said District Director of the Internal Revenue Service, or to any other proper officer of the United States. In violation of Title 26, United States Code, Section 7203. ......................... United States Attorney .......................

OCTOBER 1985

1/ If fiscal year is involved, substitute "fiscal year ended ........, 19..". Fiscal year individual returns must be filed on or before the 15th day of the fourth month after the end of the fiscal year. 26 U.S.C., Sec. 6072(a). 2/ If venue is based on defendant's principal place of business, substitute for residence, "whose principal place of business was in (City), (State),". 3/ If the amount of gross income is not to be alleged, substitute "had and received gross income in excess of $......... (minimum filing requirement)." For definition of gross income, see 26 U.S.C., Sec. 61. 4/ If April 15th fell on a Saturday, Sunday, or legal holiday, the appropriate date in the information would be next succeeding day that was not a Saturday, Sunday, or legal holiday. Note that the date the return was due should include any authorized extensions of time for filing. 26 U.S.C., Sec. 7503.

Failure to File Individual Return (district of Service Center)

FORM NO. 17

STATUTE: 26 U.S.C. Sec. 7203 - Information

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 7203 ........................ ) The United States Attorney charges: That during the calendar year 2/ 19.., (Defendant's Name) conducted a business as a partnership under the name and style of .................., with its principal place of business at (City), (State), and by reason of such facts he/she was required by law, following the close of the calendar year 2/ 19.., and on or before April 15, 19.., 3/ for and on behalf of said partnership, to make a partnership return of income to the Director, Internal Revenue Service Center, at (City), (State), in the ............... District of ..............., or to the District Director of the Internal Revenue Service for the Internal Revenue District of ..........., at .............. 1/, or other proper officer of the United States, stating specifically the items of said partnership's gross income and the deductions and credits allowed by law; that well-knowing and believing all of the foregoing, he/she did willfully fail to make a partnership return to said Director of the Internal Revenue Service Center, to said District Director of the Internal Revenue Service, or to any other proper officer of the United States. In violation of Title 26, United States Code, Section 7203. ......................... United States Attorney .......................

OCTOBER 1985

1/ If venue is to be placed in the judicial district of the District Director, modify this form in accordance with Form No. 16. 2/ If fiscal year is involved, substitute "fiscal year ended ..........., 19..". 3/ Fiscal year partnership returns must be filed on or before the 15th day of the fourth month following the close of the fiscal year. 26 U.S.C., Secs. 6031, 6072(a). Note that if the fifteenth day fell on a Saturday, Sunday, or legal holiday, the appropriate date in the information would be the next succeeding day that was not a Saturday, Sunday, or legal holiday. Note also that the date the return was due should include any authorized extensions of time for filing. 26 U.S.C., Sec. 7503.

Failure to File Partnership Return

FORM NO. 18

STATUTE: 26 U.S.C. Sec. 7203 - Information

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 7203 ........................ ) The United States Attorney charges: That during the calendar year 2/ 19.., the defendant, (Defendant's Name), 3/ was the (Position Held in Corporation) of (Name of Corporation), a corporation not expressly exempt from tax, with its principal place of business at (City), (State), and by reason of such facts he/she/it was required by law, after the close of the calendar year 2/ 19.., and on or before March 15, 19.., 4/ for and on behalf of said corporation, to make an income tax return to the Director, Internal Revenue Service Center, at (City), (State), in the ............ District of ..............., or to the District Director of the Internal Revenue Service for the Internal Revenue District of .........., at ............, 1/ or other proper officer of the United States, stating specifically the items of said corporation's gross income and the deductions and credits allowed by law; that well-knowing and believing all of the foregoing, he/she/it did willfully fail to make an income tax return to said Director of the Internal Revenue Service Center, to said District Director of the Internal Revenue Service, or to any other proper officer of the United States. In violation of Title 26, United States Code, Section 7203. ......................... United States Attorney .......................

OCTOBER 1985

1/ If venue is to be placed in the judicial district of the District Director, modify this form in accordance with Form No. 16. 2/ If fiscal year is involved, substitute "fiscal year ended ..........., 19..". 3/ If the corporation is named as the defendant, substitute the name of the corporation. 4/ Fiscal year corporation income tax returns must be filed on or before the 15th day of the third month following the close of the fiscal year. 26 U.S.C., Sec. 6072(b). Note that if the fifteenth day fell on a Saturday, Sunday, or legal holiday, the appropriate date in the information would be the next succeeding day that was not a Saturday, Sunday, or legal holiday. Note also that the date of the return was due should include any authorized extensions of time for filing. 26 U.S.C., Sec. 7503.

Failure to File Corporation Return

FORM NO. 19

STATUTE: 26 U.S.C. Sec. 7203 - Information

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 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

OCTOBER 1985

1/ Use Internal Revenue Service Center where Form 1096 was required to be filed. See Instructions for Forms 1096. Treasury Regulations on Income Tax (1954 Code), Sec. 1.6041-6 (26 C.F.R.).

Failure to File Information Return

FORM NO. 20

STATUTE: 26 U.S.C. Sec. 7203 - Information

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 7203 ........................ ) The United States Attorney charges: That during the calendar year 2/ 19.., (Defendant's Name), who was a resident of (City), (State), had and received taxable income of $........., on which taxable income there was owing to the United States of America an income tax of $.........; that he/she was required by law on or before April 15, 19.., 3/ to pay said income tax to the Director, Internal Revenue Service Center, at (City), (State), in the ............... District of ..............., or to the District Director of the Internal Revenue Service for the Internal Revenue District of ........., at ............, 1/ or other proper officer of the United States; and that well-knowing and believing all of the foregoing, he/she did willfully fail to pay the said income tax to said Director of the Internal Revenue Service Center, to said District Director of the Internal Revenue Service, or to any other proper officer of the United States. In violation of Title 26, United States Code, Section 7203. ......................... United States Attorney ......................

OCTOBER 1985

1/ If venue is to be placed in the judicial district of the District Director, modify this form in accordance with Form No. 16. 2/ If fiscal year is involved, substitute "fiscal year ended ............, 19..". 3/ If April 15th fell on a Saturday, Sunday, or legal holiday, the appropriate date in the information would be the next succeeding day that was not a Saturday, Sunday, or legal holiday. 26 U.S.C., Sec. 7503. Note that fiscal year individual returns must be filed on or before the 15th day of the fourth month after the end of the fiscal year. 26 U.S.C., Sec. 6072(a).

Failure to Pay Tax

FORM NO. 21

STATUTE: 26 U.S.C. Sec. 7203 - Information

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 7203 ........................ ) The United States Attorney charges: That during the period from (Date) to (Date), inclusive, (Defendant's Name), a resident of (City), (State), was an employer of labor 2/ and a person required under the provisions of the Internal Revenue Code to make a return of federal income taxes withheld from wages and Federal Insurance Contributions Act taxes; that during said period he/she paid wages to his/her employees which were subject to withholding of federal income taxes and Federal Insurance Contributions Act taxes in the sum of $......... and $........., respectively; that by reason of such facts he/she was required by law, after (Last Day of Period), and on or before (Return Due Date), to make an Employer's Quarterly Federal Tax Return, Form 941, to the Director, Internal Revenue Service Center, at (City), (State), in the ........... District of ............., or to the District Director of the Internal Revenue Service for the Internal Revenue District of ..........., at .............., 1/ or other proper officer of the United States; and that well-knowing and believing all of the foregoing, he/she did willfully fail to make said return to said Director of the Internal Revenue Service Center, to said District Director of the Internal Revenue Service, or to any other proper officer of the United States. In violation of Title 26, United States Code, Section 7203. ......................... United States Attorney ......................

OCTOBER 1985

1/ If venue is to be placed in the judicial district of the District Director, modify this form in accordance with Form No. 16. 2/ If employer is a corporation, refer to Form No. 19 as a guide in charging appropriate corporate officials with failure to file return on behalf of corporation.

Failure to File F.I.C.A. and Withholding Tax Return

FORM NO. 22

STATUTE: 26 U.S.C. Sec. 7203 - Information

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ................. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 7203 ........................ ) The United States Attorney charges: 1. That during the period from (Date) to (Date), inclusive, (Defendant's Name), a resident of (City), (State), was an employer of labor 2/ and a person required under the provisions of the Internal Revenue Code to make a return of federal income taxes withheld from wages and Federal Insurance Contributions Act (F.I.C.A.) taxes; that during said period he/she paid wages to his/her employees which were subject to withholding of federal income taxes and Federal Insurance Contributions Act taxes; that by reason of such facts he/she was required by law, after the close of each calendar quarter and on or before each due date, to make an Employer's Quarterly Federal Tax Return, Form 941, to the Director, Internal Revenue Service Center, at (City), (State), in the ........... District of ............, or to the District Director of the Internal Revenue Service for the Internal Revenue District of ..........., at ..............., 1/ or other proper officer of the United States; and that well-knowing and believing all of the foregoing, he/she did willfully fail to make to said Director of the Internal Revenue Service Center, 3/ to said District Director of the Internal Revenue Service, or to any other proper officer of the United States, said Employer's Quarterly Federal Tax Return, Form 941, for each of the calendar quarters hereinafter set forth during the period from (Date) to (Date). 2. The allegations of paragraph "1." herein are repeated and realleged for Counts I through ....., inclusive, of this Information, as though fully set forth therein: F.I.C.A. TAXES INCOME TOTAL (F.I.C.A. QUARTER DUE TOTAL (EMPLOYER'S & TAXES AND INCOME) COUNT ENDED DATE WAGES EMPLOYEE'S) WITHHELD TAX LIABILITY I. ...... .... ..... ............. ........ ............. II. ...... .... ..... ............. ........ ............. III. ...... .... ..... ............. ........ ............. In violation of Title 26, United States Code, Section 7203. ......................... United States Attorney .......................

OCTOBER 1985

1/ If venue is to be placed in the judicial district of the District Director, modify this form in accordance with Form No. 16. 2/ If employer is a corporation, refer to Form No. 19 as a guide in charging appropriate corporate officials with failure to file returns on behalf of corporation.

Failure to File F.I.C.A. and Withholding Tax Returns - Tabular Form Information

FORM NO. 23

STATUTE: 26 U.S.C. Sec. 7203 - Information

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 7203 ........................ ) The United States Attorney charges: That during the period from (Date) to (Date), (Defendant's Name) 2/ conducted a business as a (Sole Proprietorship or Partnership) under the name and style of ...................., with its principal place of business in (City), (State), and sold at retail 3/ (Article), upon which sales there were due and owing to the United States of America retail dealer's 4/ excise taxes in the amount of $.........; that by reason of such fact he/she was required by law, after (Last Day Of Period), and on or before (Return Due Date), to make a Quarterly Federal Excise Tax Return 5/ to the Director, Internal Revenue Service Center, at (City), (State), in the ............... District of .............., or to the District Director of the Internal Revenue Service for the Internal Revenue District of .........., at ..............., 1/ or other proper officer of the United States; that well-knowing and believing all of the foregoing, he/she did willfully fail to make said return to said Director of the Internal Revenue Service Center, to said District Director of the Internal Revenue Service, or to any other proper officer of the United States. In violation of Title 26, United States Code, Section 7203. ......................... United States Attorney ......................

OCTOBER 1985

1/ If venue is to be placed in the judicial district of the District Director, modify this form in accordance with Form No. 16. 2/ If taxpayer is a corporation, refer to Form No. 19 as a guide in charging appropriate corporate officials with failure to file return on behalf of corporation. 3/ Designate appropriate business, e.g., manufacturing. 4/ For other excise taxes, see 26 U.S.C., Secs. 4041, et seq. 5/ Designate appropriate I.R.S. form.

Failure to File Excise Tax Return

FORM NO. 24

STATUTE: 26 U.S.C. Sec. 7203 - Information

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 7204 ........................ ) The United States Attorney charges: That on or about the ...... day of ..........., 19.., in the ......... District of ..............., (Defendant's Name), 1/ a resident of (City), (State), who during the calendar year 19.. employed (Name of Employee), a resident of (City), (State), and who was required under the Internal Revenue laws to deduct and withhold federal income taxes and Federal Insurance Contributions Act taxes with respect to the wages of (Name of Employee) and to furnish him/her on or before January 31, 19.., with a written statement showing the amount of wages paid and taxes deducted and withheld during the calendar year 19.., did willfully fail to furnish said statement to said employee in the manner and at the time required by law. In violation of Title 26, United States Code, Section 7204. ......................... United States Attorney ......................

OCTOBER 1985

1/ If employer is a corporation, refer to Form No. 19 as a guide in charging appropriate corporate officials with failure to furnish a withholding statement on behalf of the corporation.

Failure to Furnish Employee's Withholding Statement

FORM NO. 25

STATUTE: 26 U.S.C. Sec. 7204 - Information

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 7204 ........................ ) The United States Attorney charges: That on or about the ...... day of ..........., 19.., in the ............ District of ..............., the defendant, (Defendant's Name), 1/ a resident of (City), (State), who during the calendar year 19.. employed (Name of Employee), a resident of (City), (State), and who was required under the Internal Revenue laws to deduct and withhold income taxes and Federal Insurance Contributions Act taxes with respect to the wages of (Name of Employee) and to furnish him/her on or before January 31, 19.., with a written statement showing the amount of wages paid and taxes deducted and withheld during the calendar year 19.., did willfully furnish a false and fraudulent statement to said employee showing that the total wages paid were $......... and that the income taxes deducted and withheld were $......... and that the Federal Insurance Contributions Act taxes deducted and withheld were $........, whereas, as (Defendant's Name) then and there well knew and believed, the total wages paid were $........., and the income taxes deducted and withheld were $......... and the Federal Insurance Contributions Act taxes deducted and withheld were $.......... In violation of Title 26, United States Code, Section 7204. ......................... United States Attorney ......................

OCTOBER 1985

1/ If the employer is a corporation, refer to Form No. 11 as a guide in charging appropriate corporate officers with furnishing a false and fraudulent withholding statement on behalf of the corporation.

Furnishing False Employee's Withholding Statement

FORM NO. 26

STATUTE: 26 U.S.C. Sec. 7204 - Information

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 7205 ........................ ) The United States Attorney charges: That on or about the ...... day of ..........., 19.., in the ........... District of .............., the defendant, (Defendant's Name), a resident of (City), (State), who during the calendar year 19.. was employed by (Name of Employer), a resident of (City), (State), and who was required under the Internal Revenue laws to furnish (Name of Employer) with a signed Employee's Withholding Allowance Certificate, Form W-4, setting forth the number of withholding allowances claimed on or about the date of the commencement of employment by (Name of Employer), did willfully supply a false and fraudulent Employee's Withholding Allowance Certificate, Form W-4, to (Name of Employer), on which he/she claimed ........ withholding allowances, whereas, as (Defendant's Name) then and there well knew and believed, he/she was entitled to claim only ........ withholding allowances. In violation of Title 26, United States Code, Section 7205. ......................... United States Attorney

OCTOBER 1985

False Withholding Allowance Certificate

FORM NO. 27

STATUTE: 26 U.S.C. Sec. 7205 - Information

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 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 1/ a (Describe Document), which was verified by a written declaration that it was made under the penalties of perjury and was filed with the Director, Internal Revenue Service Center, at (City), (State), 2/ which said (Describe Document) he/she did not believe to be true and correct as to every material matter in that the said (Describe Document And The False Fact(s)), whereas, as he/she then and there well knew and believed, (Describe Correct Fact(s)). In violation of Title 26, United States Code, Section 7206(1). A True Bill. ......................... Foreperson ......................... United States Attorney ......................

OCTOBER 1985

1/ An aider and abettor may be jointly charged with the principal under 18 U.S.C., Sec. 2. If this is done, the language "and did willfully aid, abet, assist, and cause to be so made and subscribed" should be inserted after the word "subscribe" and appropriate reference made to 18 U.S.C., Sec. 2, as well as to 26 U.S.C., Sec. 7206(1). 2/ If the Service Center was not the place of filing, substitute "with the District Director of the Internal Revenue Service for the Internal Revenue District of ..........., at ............."; or "with the Representative of the District Director of the Internal Revenue Service for the Internal Revenue District of ............, at ...............".

Making and Subscribing False Return, Statement, or Other Document (district of filing)

FORM NO. 28

STATUTE: 26 U.S.C. Sec. 7206(1) - Indictment

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 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 1/ a (Describe Document), 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 (Describe Document) he/she did not believe to be true and correct as to every material matter in that the said (Describe Document and the False Fact(s)), whereas, as he/she then and there well knew and believed, (Describe Correct Fact(s)). In violation of Title 26, United States Code, Section 7206(1). A True Bill. ......................... Foreperson ......................... United States Attorney ......................

OCTOBER 1985

1/ An aider and abettor may be jointly charged with the principal under 18 U.S.C., Sec. 2. If this is done, the language "and did willfully aid, abet, assist, and cause to be so made and subscribed" should be inserted after the word "subscribe" and appropriate reference made to 18 U.S.C., Sec. 2, as well as to 26 U.S.C., Sec. 7206(1).

Making and Subscribing False Return, Statement, or Other Document (district of preparation and signing)

FORM NO. 29

STATUTE: 26 U.S.C. Sec. 7206(1) - Indictment

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 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 1/ a (joint) U.S. Individual Income Tax Return, 2/ for the calendar year 3/ 19.., which was verified by a written declaration that it was made under the penalties of perjury and was filed with the Internal Revenue Service, 4/ which said income tax return he/she did not believe to be true and correct as to every material matter in that the said return reported (State Each False Item of Income Reported, e.g., Dividend Income in the Amount of $........., Interest Income 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., Interest Income and Dividend Income) in addition to that heretofore stated. In violation of Title 26, United States Code, Section 7206(1). A True Bill. ......................... Foreperson ......................... United States Attorney ......................

OCTOBER 1985

1/ An aider and abettor may be jointly charged with the principal under 18 U.S.C., Sec. 2. If this is done, the language "and did willfully aid, abet, assist, and cause to be so made and subscribed" should be inserted after the word "subscribe" and appropriate reference made to 18 U.S.C., Sec. 2, as well as to 26 U.S.C., Sec. 7206(1). 2/ Where appropriate, substitute correct tax return, e.g., U.S. Corporation Income Tax Return. 3/ If fiscal year is involved, substitute "fiscal year ended ..........., 19..". 4/ If venue is to be placed in the district of filing, modify this form in accordance with Form No. 28.

Making and Subscribing False Income Tax Return - Open-Ended Indictment

FORM NO. 30

STATUTE: 26 U.S.C. Sec. 7206(1) - Indictment

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............. UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 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 (joint) U.S. Individual Income Tax Return, for the calendar year 19.., 1/ which was verified by a written declaration that it was made under the penalties of perjury and was filed with the Internal Revenue Service, 2/ which said income tax return he/she did not believe to be true and correct as to every material matter in that the said return failed to disclose that he/she was engaged in the operation of a business activity from which he/she derived gross receipts or sales and incurred deductions, whereas, as he/she then and there well knew and believed, he/she was required by law and regulation to disclose the operation of this business activity, the gross receipts or sales he/she derived therefrom, and the deductions he/she incurred. In violation of Title 26, United States Code, Section 7206(1). A True Bill. ......................... Foreperson ......................... United States Attorney ......................

OCTOBER 1985

1/ If fiscal year is involved, substitute "fiscal year ended ............, 19..". 2/ If venue is to be placed in the district of filing, modify this form in accordance with Form No. 28.

Making and Subscribing False Return - Failure to Disclose a Business

FORM NO. 31

STATUTE: 26 U.S.C. Sec. 7206(1) - Indictment

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............ DISTRICT OF ............. UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 7206(2) ........................ ) The grand jury charges: That on or about the ...... day of ............, 19.., in the ........... District of ................., the defendant, (Defendant's Name), a resident of (City), (State), did willfully aid and assist in, and procure, counsel, and advise the preparation and presentation to the Internal Revenue Service, of a U.S. Individual Income Tax Return, Form 1040, 1/ of (Taxpayer's Name) for the calendar year 2/ 19.., which was false and fraudulent as to a material matter, in that (Describe False Fact(s), e.g., it represented that the said (Taxpayer's Name) was entitled under the provisions of the Internal Revenue laws to claim deductions in the total sum of $.........), whereas, as the defendant then and there well knew and believed, (Describe Correct Fact(s), e.g., the total deductions which the said (Taxpayer's Name) was entitled to claim for said calendar year were in the total sum of $.........). In violation of Title 26, United States Code, Section 7206(2). A True Bill. ......................... Foreperson ......................... United States Attorney ......................

OCTOBER 1985

1/ Designate appropriate document if not a tax return, e.g., a financial statement. 2/ If fiscal year is involved, substitute "fiscal year ended ............, 19..".

Aiding and Assisting in Preparation and Presentation of False Return/Document

FORM NO. 32

STATUTE: 26 U.S.C. Sec. 7206(2) - Indictment

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............ DISTRICT OF ............. UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 7206(2) ........................ ) The grand jury charges: 1. That on or about the ...... day of ............, 19.., in the ........... District of ................, the defendant, (Defendant's Name), a resident of (City), (State), did willfully aid and assist in, and procure, counsel, and advise the preparation and presentation to the Internal Revenue Service, of U.S. Individual Income Tax Returns, Forms 1040, either individual or joint, for the taxpayers and calendar years hereinafter specified, which were false and fraudulent as to material matters, in that they represented that the said taxpayers were entitled under the provisions of the Internal Revenue laws to claim deductions for items and in amounts hereinafter specified, whereas, as the defendant then and there well knew and believed, the said taxpayers were not entitled to claim deductions in said amounts, but of lesser amounts. 2. The allegations of paragraph "1." are repeated and realleged in Counts I through ......, inclusive, of this Indictment, as though fully set forth therein: DATE OF CALENDAR FALSELY AMOUNT COUNT OFFENSE TAXPAYER TAX YEAR CLAIMED ITEM 1/ CLAIMED I. ....... ........ ........ ............... ....... II. ....... ........ ........ ............... ....... III. ....... ........ ........ ............... ....... In violation of Title 26, United States Code, Section 7206(2). A True Bill. ......................... Foreperson ......................... United States Attorney ......................

OCTOBER 1985

1/ Where the fraudulent deductions (generally itemized deductions) consist of alleged payments to individuals or organizations, list each fraudulent payment, rather than totalling such payments in the deduction category under which they were claimed on the return. For example, list "Medical Expenses Dr. Jones-$500; Dr. Smith-$500," not, "Medical Expenses $1,000." This will prevent a defense that additional, unclaimed deductions in the same deduction category are available to offset the false items.

Aiding and Assisting in Preparation and Presentation of False Returns - Tabular Form Indictment

FORM NO. 33

STATUTE: 26 U.S.C. Sec. 7206(2) - Indictment

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 7206(4) ........................ ) The grand jury charges: That on or about the ...... day of ............, 19.., in the ........... District of ..............., (Defendant's Name), a resident of (City), (State), with intent to evade and defeat the collection of income taxes assessed against him/her on or about ............, 19.., by the Internal Revenue Service, 1/ did knowingly and unlawfully remove and conceal (Describe Property), upon which levy was authorized by Section 6331 of the Internal Revenue Code. In violation of Title 26, United States Code, Section 7206(4). A True Bill. ......................... Foreperson ......................... United States Attorney ......................

OCTOBER 1985

1/ Where appropriate, substitute "evade and defeat the assessment of income taxes against him/her by the Internal Revenue Service."

Removal or Concealment of Property with Intent to Evade Assessment or Collection of Tax

FORM NO. 34

STATUTE: 26 U.S.C. Sec. 7206(4) - Indictment

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 7206(5)(A) ........................ ) The grand jury charges: That on or about the ...... day of ..........., 19.., in the .......... District of ..............., (Defendant's Name), a resident of (City), (State), in connection with an offer of compromise 1/ relating to his/her liability for (Type Of Tax) taxes due and owing by him/her to the United States of America for the calendar year(s) ........., 2/ did willfully conceal from (Specify Particular Officer, With Job Title) and all other proper officers and employees of the United States, (Describe Property Belonging to Taxpayer or Other Person Liable for the Tax). In violation of Title 26, United States Code, Section 7206(5)(A). A True Bill. ......................... Foreperson ......................... United States Attorney ......................

OCTOBER 1985

1/ Where appropriate, substitute "a compromise"; or "a closing agreement"; or "an offer to enter into a closing agreement". 2/ If fiscal year is involved, substitute "fiscal year(s) ended ............., 19..".

Concealment of Assets With Compromise or Closing Agreement (Sec. 7206(5)(A))

FORM NO. 35

STATUTE: 26 U.S.C. Sec. 7206(5) - Indictment

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............ DISTRICT OF .............. UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 7206(5)(B) ........................ ) The grand jury charges: That on or about the ...... day of ............, 19.., in the ............ District of ..............., (Defendant's Name), a resident of (City), (State), in connection with an offer of compromise 1/ relating to his/her liability for (Type Of Tax) taxes due and owing by him/her to the United States of America for the calendar year(s) .........., 2/ did willfully ((receive) (withhold) (destroy) (mutilate) or (falsify), Describe Book, Document, or Record Involved) 3/. In violation of Title 26, United States Code, Section 7206(5)(B). A True Bill. ......................... Foreperson ......................... United States Attorney ......................

OCTOBER 1985

1/ Where appropriate, substitute "a compromise"; or "a closing agreement"; or "an offer to enter into a closing agreement". 2/ If fiscal year is involved, substitute "fiscal year(s) ended ............, 19..". 3/ Where false statement is the crime, substitute "make a false statement to (Name Appropriate Official, With Job Title), at (Place), (Location), wherein (Defendant's Name) stated that (Describe False Statement Relating to the Estate or Financial Condition of Taxpayer), whereas, as he/she then and there well knew and believed, (Describe Correct Fact(s) Relating to False Statement)".

Destruction, Falsification, etc., of Records or False Statement With Compromise or Closing Agreement (Sec. 7206(5)(B))

FORM NO. 36

STATUTE: 26 U.S.C. Sec. 7206(5) - Indictment

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE .............. DISTRICT OF ............. UNITED STATES OF AMERICA ) ) v. ) No. ....................... ) 26 U.S.C., Sec. 7207 1/ ........................ ) The United States Attorney charges: That on or about the ...... day of ............, 19.., in the .......... District of .............., the defendant, (Defendant's Name), a resident of (City), (State), did willfully deliver and disclose by submitting to an Officer(s) of the Internal Revenue Service, United States Treasury Department, at (Place), (Location), a (Describe Document, e.g., List, Account, Statement, or Other Document), 2/ which was known by the defendant to be fraudulent and false as to a material matter in that (Describe the False Fact(s)), whereas, as he/she then and there well knew and believed, (Describe the Correct Fact(s)). In violation of Title 26, United States Code, Section 7207. ......................... United States Attorney ......................

OCTOBER 1985

1/ Department policy limits Section 7207 prosecutions to cases involving the falsification of documents other than U.S. tax returns. See Sec. 16.03, Policy Limiting The Use Of Sec. 7207, supra. 2/ A separate count should be charged for each false document.

False Document (district of submission)

FORM NO. 37

STATUTE: 26 U.S.C. Sec. 7207 - Information

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............ DISTRICT OF ............. UNITED STATES OF AMERICA ) ) v. ) No. ........................ ) 26 U.S.C., Sec. 7207 1/ ........................ ) The United States Attorney charges: That on or about the ...... day of ..........., 19.., in the ........... District of ..............., the defendant, (Defendant's Name), a resident of (City), (State), did willfully deliver and disclose, by mailing and causing to be mailed, to an Officer(s) of the Internal Revenue Service, United States Treasury Department, a (Describe Document, e.g., List, Account, Statement, or Other Document), 2/ which was known by the defendant to be fraudulent and false as to a material matter in that (Describe the False Fact(s)), whereas, as he/she then and there well knew and believed, (Describe the Correct Fact(s)). In violation of Title 26, United States Code, Section 7207. ......................... United States Attorney ......................

OCTOBER 1985

1/ Department policy limits Section 7207 prosecutions to cases involving the falsification of documents other than U.S. tax returns. See Sec. 16.03, Policy Limiting The Use Of Sec. 7207, supra. 2/ A separate count should be charged for each false document.

False Document (district of mailing)

FORM NO. 38

STATUTE: 26 U.S.C. Sec. 7207 - Information

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. ........................ ) 26 U.S.C., Sec. 7207 1/ ........................ ) The United States Attorney charges: 1. That on or about the dates hereinafter specified, in the ......... District of ............., the defendant, (Defendant's Name), a resident of (City), (State), did willfully deliver and disclose by submitting to an Officer(s) of the Internal Revenue Service, United States Treasury Department, at (Place), (Location), documents hereinafter specified, 2/ known by the defendant to be fraudulent and false as to a material matter, as hereinafter specified. 2. The allegations of paragraph "1." are repeated and realleged in Counts I through ......, inclusive, of this Information, as though fully set forth therein. COUNT DATE OF OFFENSE DESCRIPTION OF DOCUMENT FALSITY I. ............... ....................... ........... II. ............... ....................... ........... III. ............... ....................... ........... In violation of Title 26, United States Code, Section 7207. ......................... United States Attorney ......................

OCTOBER 1985

1/ Department policy limits Section 7207 prosecutions to cases involving the falsification of documents other than U.S. tax returns. See Sec. 16.03, Policy Limiting The Use Of Sec. 7207, supra. 2/ A separate count should be charged for each false document.

False Documents - Tabular Form Information (district of submission)

FORM NO. 39

STATUTE: 26 U.S.C. Sec. 7207 - Information

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............ DISTRICT OF ............. UNITED STATES OF AMERICA ) ) v. ) No. ........................ ) 26 U.S.C., Sec. 7207 1/ ........................ ) The United States Attorney charges: 1. That on or about the dates hereinafter specified, in the ........... District of ..........., the defendant, (Defendant's Name), a resident of (City), (State), did willfully deliver and disclose, by mailing and causing to be mailed, to an Officer(s) of the Internal Revenue Service, United States Treasury Department, documents hereinafter specified, 2/ known by the defendant to be fraudulent and false as to a material matter, as hereinafter specified. 2. The allegations of paragraph "1." are repeated and realleged in Counts I through ......, inclusive, of this Information, as though fully set forth therein. COUNT DATE OF OFFENSE DESCRIPTION OF DOCUMENT FALSITY I. ............... ....................... ........... II. ............... ....................... ........... III. ............... ....................... ........... In violation of Title 26, United States Code, Section 7207. ......................... United States Attorney ......................

OCTOBER 1985

1/ Department policy limits Section 7207 prosecutions to cases involving the falsification of documents other than U.S. tax returns. See Sec. 16.03, Policy Limiting The Use Of Sec. 7207, supra. 2/ A separate count should be charged for each false document.

False Documents - Tabular Form Information (district of mailing)

FORM NO. 40

STATUTE: 26 U.S.C. Sec. 7207 - Information

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............ DISTRICT OF ............. UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 7210 ........................ ) The United States Attorney charges: That on or about the ...... day of ..........., 19.., in the ............ District of ............, (Defendant's Name), a resident of (City), (State), was required under the Internal Revenue laws, by reason of being duly summoned, to appear to testify 1/ at ............ on the aforesaid date at the office of ...............; that well-knowing and believing all of the foregoing, he/she willfully failed to appear to testify 1/ at the time and place required by the summons. In violation of Title 26, United States Code, Section 7210. ......................... United States Attorney ......................

OCTOBER 1985

1/ Where appropriate, add or substitute "and produce (Describe Documents Summoned)".

Failure to Appear in Response to Summons

FORM NO. 41

STATUTE: 26 U.S.C. Sec. 7210 - Information

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............ DISTRICT OF ............. UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 26 U.S.C., Sec. 7215 ........................ ) The United States Attorney charges: 1. That during the period ............, 19.., to ............, 19.., in the ........... District of ............, (Defendant's Name) was an employer of labor 1/ required under the provisions of the Internal Revenue Code to collect, account for, and pay over to the United States federal income taxes and Federal Insurance Contributions Act (F.I.C.A.) taxes withheld from wages. 2. That (Defendant's Name) did fail at the time and in the manner prescribed by the Internal Revenue Code, and Regulations promulgated pursuant thereto, to collect, truthfully account for, and pay over and to make deposits and payments of the said withheld taxes to the United States, which were due and owing for the quarters ending ..........., 19.., ..........., 19.., ............, 19.., and ..........., 19... 2/ 3. That on ..........., 19.., (Defendant's Name) was notified of such failure by notice delivered in hand to him/her as provided by Title 26, United States Code, Section 7512, which said notice advised him/her that he/she was required to collect the aforesaid taxes that became collectible after delivery of such notice, and, not later than the end of the second banking day after such collection, to deposit said taxes in a separate bank account established by him/her in trust for the United States to be kept therein until paid over to the United States. 4. That within the ............... District of ..............., (Defendant's Name) unlawfully failed to comply with the provisions of Title 26, United States Code, Section 7512, in that, after receiving delivery of the notice referred to in paragraph "3.", he/she paid wages and was required to collect and deposit the said taxes, but failed to deposit said taxes in a separate bank account in trust for the United States, by the dates and in the amounts hereinafter specified: DATE WAGES DATE DEPOSIT AMOUNT OF COUNT PAID REQUIRED DEPOSIT REQUIRED I. .......... ............ $................ II. .......... ............ $................ III. .......... ............ $................ IV. .......... ............ $................ In violation of Title 26, United States Code, Section 7215. ......................... United States Attorney ......................

OCTOBER 1985

1/ If the employer is other than a sole proprietorship (e.g., a corporation, partnership, or joint venture), the relationship of the defendant to the employer-entity, which makes him the responsible person, should be alleged in paragraphs 1, 2, and 3, by substituting "(Defendant's Name), who was the (Position Held) in Company) of (Name of Company), a (Type of Company, e.g., Corporation, Partnership, etc.), and an employer of labor". 2/ Quarters prior to notice for which there was a failure to collect, account for, and pay over federal income and F.I.C.A. taxes withheld from wages.

Failure to Make Trust Fund Deposit

FORM NO. 42

STATUTE: 26 U.S.C. Sec. 7215 - Information

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............ DISTRICT OF ............. UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 18 U.S.C., Sec. 287 ........................ ) The grand jury charges: That on or about the ...... day of ..........., 19.., in the ........... District of ............, (Defendant's Name), a resident of (City), (State), 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 and by signing and causing to be signed, 1/ a U.S. Individual Income Tax Return, Form 1040, 2/ 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 ......................

OCTOBER 1985

1/ If venue is to be placed in the district of filing, modify this form in accordance with Form No. 2. If venue is based on mailing, substitute "by mailing and causing to be mailed". 2/ Designate appropriate I.R.S. form, e.g., U.S. Corporation Income Tax Return, Form 1120.

False Claim for Refund

FORM NO. 43

STATUTE: 18 U.S.C. Sec. 287 - Indictment

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............ DISTRICT OF ............. UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 18 U.S.C., Sec. 371 ........................ ) The grand jury charges: THE CONSPIRACY 1. 1/ From on or about (Date), the exact date being unknown to the Grand Jury, and continuing thereafter up to and including the date of this indictment 2/, in the ............... District of ..............., (Defendant's Name) (Defendant's Name) (Defendant's Name) defendants herein, did unlawfully, willfully, and knowingly conspire, combine, confederate, and agree together and with each other and with other individuals both known and unknown to the Grand Jury to defraud 3/ the United States by impeding, impairing, obstructing, and defeating the lawful Government functions of the Internal Revenue Service of the Treasury Department in the ascertainment, computation, assessment, and collection of the revenue: to wit, income taxes. PARTIES, PERSONS AND ENTITIES At all relevant times, 2. (E.g., Defendants John Smith and Tom Smith were president and vice president of Smith, Inc., a corporation, and each owned 50% of the stock of Smith, Inc.) 3. (E.g., Defendant Sam Jones was a certified public accountant who prepared the income tax returns of Smith, Inc., a corporation, and its officers) 4. (E.g., Smith, Inc., was a Massachusetts corporation, formed in 1975 by defendant John Smith to market real estate limited partnerships) 5. (Continue to describe all defendants and all persons and entities that are significant to an understanding of the conspiracy) MANNER AND MEANS BY WHICH THE CONSPIRACY WAS CARRIED OUT The manner and means by which the conspiracy was sought to be accomplished included, among others, the following: 6. (Describe manner or means, e.g., To divert corporate receipts to their own use, defendant John Smith presented false books and records to the corporate accountant for use in preparing the corporate income tax returns of Smith, Inc., for the calendar years 1978, 1979, and 1980) 7. (E.g., By backdating documents so as to conceal from the Internal Revenue Service defendant John Smith's ownership and interest in real property) 8. (E.g., By making false statements and representations to agents of the Internal Revenue Service for the purpose of concealing the interest of defendant John Smith in property, stock, etc.) 9. (Continue to describe general manner and means used to carry out the conspiracy) OVERT ACTS In furtherance of the conspiracy, and to effect the objects thereof, the following overt acts were committed in the ........... District of ..............., and elsewhere: 10. (E.g., On or about July 20, 1978, defendant Tom Smith and Jane Smith met in the offices of Smith Realty Co. at 33 Main Street, Boston, Massachusetts, and discussed how to backdate real estate contracts) 11. (E.g., In or about the week of July 20, 1978, defendants John Smith and Tom Smith went to the A. and B. Bank in Boston, Massachusetts, and removed cash from the safe deposit box of defendant John Smith) In violation of Title 18, United States Code, Section 371. A True Bill. ......................... Foreperson ......................... United States Attorney ......................

OCTOBER 1985

1/ It is suggested that the paragraphs of the indictment be numbered sequentially from beginning to end even though the indictment will have different sections. This will eliminate confusion when reference is made to a particular portion or paragraph of the indictment. 2/ Substitute appropriate date if the conspiracy ended before the date of the indictment. 3/ Substitute appropriate language if conspiracy is to commit a substantive offense, e.g., "to commit offenses against the United States: to wit, to violate Title 26, United States Code, Sections 7201 and 7206(1)."

Conspiracy to Defraud/Evade Taxes

FORM NO. 44

STATUTE: 18 U.S.C. Sec. 371 - Indictment

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............ DISTRICT OF ............. UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 18 U.S.C., Sec. 1001 ........................ ) The grand jury charges: That on or about the ...... day of ..........., 19.., (Defendant's Name), a resident of (City), (State), did willfully and knowingly make and cause to be made a false, fictitious, and fraudulent statement(s) and representation(s) in a matter within the jurisdiction of a department or agency of the United States by (Describe False Statement or Representation and Describe Official to Whom False Statement Was Made), at (Place), (Location), in the ........... District of ..............., whereas, as (Defendant's Name) then and there well knew and believed, (Describe Correct Fact(s) Regarding the False Statement or Representation). In violation of Title 18, United States Code, Section 1001. A True Bill. ......................... Foreperson ......................... United States Attorney

OCTOBER 1985

False Statement or Representation

FORM NO. 45

STATUTE: 18 U.S.C. Sec. 1001 - Indictment

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............. DISTRICT OF ............ UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 18 U.S.C., Sec. 1001 ........................ ) The grand jury charges: That on or about the ...... day of .........., 19.., (Defendant's Name), a resident of (City), (State), did willfully and knowingly make and cause to be made, and use and cause to be used, a false writing or document, knowing the same to contain a false, fictitious, and fraudulent statement, in a matter within the jurisdiction of a department or agency of the United States, by submitting (Describe False Document and False Statement(s) Within Document and Describe Official to Whom the False Document Was Submitted), at (Place), (Location), in the ............. District of .............., whereas, as (Defendant's Name) then and there well knew and believed, (Describe Correct Fact(s) Regarding False Document). In violation of Title 18, United States Code, Section 1001. A True Bill. ......................... Foreperson ......................... United States Attorney

OCTOBER 1985

False Document

FORM NO. 46

STATUTE: 18 U.S.C. Sec. 1001 - Indictment

CHAPTER: Forms

CRIMINAL TAX MANUAL

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ............ DISTRICT OF ............. UNITED STATES OF AMERICA ) ) v. ) No. ..................... ) 18 U.S.C., Sec. 1001 ........................ ) The grand jury charges: From on or about the ...... day of ..........., 19.., to on or about the ...... day of ..........., 19.., in the ........... District of ............., (Defendant's Name), a resident of (City), (State), did willfully and knowingly falsify, conceal, and cover up, by trick, scheme, or device, in a matter within the jurisdiction of a department or agency of the United States, by (Describe Nature of Scheme or Device to Conceal, Including Name and Title of any IRS Employee to Whom False Statement(s) or Representation(s) Were Made; Nature of False Statement(s) or Representation(s); Place and Location Where False Statement(s) or Representation(s) Were Made; and/or Specific False Document(s) Submitted 1/), whereas, as (Defendant's Name) then and there well knew and believed, (Describe Correct Facts Relating to False Statement(s), Representation(s), and/or Document(s) 2/). In violation of Title 18, United States Code, Section 1001. A True Bill. ......................... Foreperson ......................... United States Attorney ......................

OCTOBER 1985

1/ E.g., "by representing to John Smith, Revenue Officer, Internal Revenue Service, at 33 Main Street, Boston, Massachusetts, that the deductions claimed for contributions were in the amount of $........., and that eight checks drawn on account number ..............., at ........................... Bank, were issued to make the contributions in the amounts represented on said checks". 2/ E.g., "the said eight checks had been altered and were false as to ........................ (amounts, payees, dates, etc.)".

Falsify or Conceal By Scheme or Device A Material Fact

FORM NO. 47

STATUTE: 18 U.S.C. Sec. 1001 - Indictment

CHAPTER: Forms

CRIMINAL TAX MANUAL

FORM NO. 1. Complaint to Toll Statute of lLimitations 26 U.S.C., Sec. 7201 - Attempt to Evade - Indictment 2. Individual (district of filing) 3. Individual (district of preparation) 4. Individual (joint return - district of filing) 5. Individual (joint return - district of preparation) 6. Individual (community property return) 7. Individual (community property return of spouse) 8. Individual (acts subsequent to filing - 'Beacon Brass') 9. Individual (no return - 'Spies' evasion) 10. Individual (evasion of payment) 11. Corporation (false return) 12. Corporation (acts subsequent to filing - 'Beacon Brass') 13. Withholding and F.I.C.A. Taxes (Employer's Quarterly Return) 14. Excise Tax (Quarterly Return) 26 U.S.C., Sec. 7202 - Indictment 15. Failure to Account For and Pay Over Withholding and F.I.C.A. Taxes 26 U.S.C., Sec. 7203 - Information 16. Failure to File Individual Return (district of District Director, Hand-Carried Return) 17. Failure to File Individual Return (district of Service Center) 18. Failure to File Partnership Return 19. Failure to File Corporation Return 20. Failure to File Information Return 21. Failure to Pay Tax 22. Failure to File F.I.C.A. and Withholding Tax Return 23. Failure to File F.I.C.A. and Withholding Tax Returns - Tabular Form Information 24. Failure to File Excise Tax Return 26 U.S.C., Sec. 7204 - Information 25. Failure to Furnish Employee's Withholding Statement 26. Furnishing False Employee's Withholding Statement 26 U.S.C., Sec. 7205 - Information 27. False Withholding Allowance Certificate 26 U.S.C., Sec. 7206(1) - Indictment 28. Making and Subscribing False Return, Statement, or Other Document (district of filing) 29. Making and Subscribing False Return, Statement, or Other Document (district of preparation and signing) 30. Making and Subscribing False Income Tax Return - Open-Ended Indictment 31. Making and Subscribing False Return - Failure to Disclose A Business 26 U.S.C., Sec. 7206(2) - Indictment 32. Aiding and Assisting in Preparation and Presentation of False Return/Document 33. Aiding and Assisting in Preparation and Presentation of False Returns - Tabular Form Indictment 26 U.S.C., Sec. 7206(4) - Indictment 34. Removal or Concealment of Property with Intent to Evade Assessment or Collection of Tax 26 U.S.C., Sec. 7206(5) - Indictment 35. Concealment of Assets With Compromise or Closing Agreement (Sec. 7206(5)(A)) 36. Destruction, Falsification, etc., of Records or False Statement With Compromise or Closing Agreement (Sec. 7206(5)(B)) 26 U.S.C., Sec. 7207 - Information 37. False Document (district of submission) 38. False Document (district of mailing) 39. False Documents - Tabular Form Information (district of submission) 40. False Documents - Tabular Form Information (district of mailing) 26 U.S.C., Sec. 7210 - Information 41. Failure to Appear in Response to Summons 26 U.S.C., Sec. 7215 - Information 42. Failure to Make Trust Fund Deposit 18 U.S.C., Sec. 287 - Indictment 43. False Claim for Refund 18 U.S.C., Sec. 371 - Indictment 44. Conspiracy to Defraud/Evade Taxes 18 U.S.C., Sec. 1001 - Indictment 45. False Statement or Representation 46. False Document 47. Falsify or Conceal By Scheme or Device A Material Fact

OCTOBER 1985

TABLE OF CONTENTS

CHAPTER: Forms

CRIMINAL TAX MANUAL