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18 U.S.C. § 1001
False Statement or Representation
Made to Department/Agency of U.S.IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ____________ DISTRICT OF ____________
UNITED STATES OF AMERICA
v.
_______________________
)
)
)
)
)No. __________________
18 U.S.C., § 1001The 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
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Uploaded April 1998
