EFTA00151362.pdf

U.S. Department of Justice United States Attorney Southern District of New York The Silvio J. Mollo Building One saint Andrew's Plaza New York. Mn, York 10007 Dear Sir/Madam: This letter describes the procedure for requesting reimbursement for subpoenaed records. 12 CFR part 219 (subpart A), issued by the Board of Governors of Federal Reserve System under section 1115 of the Right to Financial Privacy Act (12 U.S.C. 3415), sets the rates and conditions for reimbursement of costs directly incurred by financial institutions in assembling or providing customer financial records to a government authority pursuant to the Act. No costs are reimbursable if the records are those of a corporation or a partnership comprised of more than five individuals. If reimbursement is authorized, and the estimated billin to the government will exceed $500, advance permission is necessary from If the subpoenaed records indicated on the rider are eligible for reimbursement, please complete section B of the enclosed form OBD-211, which will serve as your invoice, and return it with a copy of the subpoena to the following address: U.S. Attorney's Office - SDNY Accounts Payable 86 Chambers Street, 3rd floor New York, NY 10007 Please send your invoice to the above address within 60 days of the submission of the subpoenaed records. If no invoice is received within 120 days, funds will not be available to pay the invoice. Thank you, Account Payable Department 212-637-2662 Enclosure: OBD- 211 EFTA00151362 FORM OBD 211 - INSTRUCTIONS ATTORNEYS: 1. Fill in blocks 2, 3, 4 (name only), 8, 9, and 10. 2. flail the subpoena and the OBD 211 to the financial institution. 3. Send a copy of the OBD 211 and the subpoena to Anthony Baker in the Budget Office. FINANCIAL OFFICIAL COMPLETE THE FOLLOWING: 1. Complete block 4. 2. Either complete block 11 or write "see attached invoice" and attach to the OBD 211. 3. Blocks 12 and 13 must be completed. Note carefully the certification. 4. Send completed OBD 211 and attached invoice, if applicable, to: U.S. Attorney's Office - SDNY Accounts Payable 86 Chambers Street - 3" Floor New York, NY 10007 EFTA00151363 Form OBD 211 U.S. Department of Justice Request for Financial Information (AuthorizatiOn. Purchase Order, Receiving Report) This form shall only be used when requesting financial records of individuals and partnerships of five or fewer individuals. I Purchase Order Number/DC Number 2 Date Order Prepared: 3 Case Number: 2019801188 Section A —Authorization and Purchase Order 4 Name and Address of Financial Institution/Tax ID 8/Name & Phone # of Contact Person SunTrust Bank 5 Deliver To: See attached subpoena for delivery instructions. 6 Return Date: See attached. 7 Remarks/Invoice # Account Number: I. If reimbursement is authorized, and the estimated billing to the government will exceed $500, advance permission is necessary from 2. See attached subpoena and rider for account information and delivery instructions. 8 Name of Re uestor/Assistant U.S. Attorney 9 Telephone Number: 10 Date of Request: 12/11/19 Section B — Financial Institution Invoice No Payment Shall Be Made Unless Expenses Are Itemized Below Or On Your Form To Be Attached. 11 Service/Financial Records Provided: Ila Billed To: Quantity Unit Price Amount Cost Pcr I hereby certify that the services above were not performed relative to any corporation, joint ventures, etc., and pertain only to accounts (checking, savings, share, loan, or credit card) of individual(s) or partnership(s) of five or fewer partners. 12 Signature of Financial Institution Official: 13 Date Signed: Total Amount Claimed By Financial Institution: Section C — Receiving Report 16 Disallowance 14 I certify that the articles and services listed were received: 15 Date Received 17 Net To Financial Institution 18 Right to Financial Privacy Act — Public Law 95-630 (12 U.S.C. 3401-3422) Request Pursuant To: (Check One Only) OBJECT CLASS a 3404 Customer Authorization 2540 a 3405 Administrative Subpoena or Summons 2541 0 3406 Search Warrant 2542 a 3407 Judicial Subpoena 2543 o 3408 Formal Written Request 2544 a 3413 Grand Jury Subpoena 2545 0 3414 Special Procedures 2546 19 Signature of Approving Official 20 Accounting Classification Code FY FC 1 12 3 4 5 PROJ 21 Schedule and Voucher Number EFTA00151364