EFTA01338104.pdf

Col SDNY_GM_02771792 SUBJECT TO PROTECTIVE ORDER PARAGRAPHS 7, 8, 9, 10, 15, and 17 EFTA_00258600 EFTA01338104  ‘• - O6/OG •- O sios s,0ck • s 4,47o its3ikra, SONYGhl_ 02771793 SUBJECT TO PROTECTIVE ORDER PARAGRAPHS 7, 8, 9, 10, 15, and 17 EFTA_00258601 EFTA01338105  U.S. Department of Justice United States Attorney Southern District ofFlorida 100 South Aartralian Avenue. State 400 Was Palm Beach. Florida 33401-6215 Tel: (161)8204M Far: (561)8204777 June 007 VIA FACSIMILE Colonial Bank Attn: Anita Muller Research Department 1853 Data Drive Hoover, AL 35243 Re: Federal Grand Jury Subpoenas OLY-01 and OLY-28 Dear Ms. Muller: write to follow up on Colonial Bank's response to two federal grand jury subpoenas numbered OLY-0I and OLY-28. Colonial Bank has responded to both of these subpoenas, but it appears that some items are incomplete. I have enclosed copies of the subpoenas, but, in short, they seek all account opening documentation and correspondence related to Jeffrey Epstein, Sarah Kellen, Nada [or Nadia] Marcinkova, Janusz Banasiak [or Banasiar], Adriana Mucinska, Alfredo Rodriguez, Adriana Ross, NES, LLC, Jeffrey Epstein Household, and JEGE, Inc. The subpoenas also ask for account statements, canceled checks, and billing statements for accounts and credit cards related to those individuals/entites for the period of January 1, 2004 through December 31, 2006. The items that appear to be missing are: ( I ) Billing statements for VISA account number 4470 1153 4000 8274 for the period of February 1, 2005 through April 30, 2005. SDNY_GM_02771794 SUBJECT TO PROTECTIVE ORDER PARAGRAPHS 7, 8, 9, 10, 15, and 17 EFTA_00258602 EFTA01338106 n Anita Muller-Page 2 (2) Billing statements for the following VISA account numbers for the period of January 1, 2004 through December 31, 2006: 4470 1153 4000 5510 4470 1153 4000 8175 4470 1153 4000 7805 4470 1153 4000 7128 4470 1153 4000 8159 4470 1153 4000 5601 (3) Account statements and canceled checks for the period of January 1, 2004 through December 31, 2006, for accounts in the names of Nada [or Nadia] Marcinkova and/or Adriana Mucinska. (4) Account statements, account opening documents, correspondence and canceled checks (front and back), related to a multitude of accounts related to Mr. Epstein, including account numbers 00110003094 00110097453 00110003162 07166030107 00110019191 0009230000122560 From the review of the documents we have received thus far, it appears that there probably are several more accounts related to Mr. Epstein and the other listed individuals/entities. For example, there appear to be several more VISA cards associated with the NES, LLC master account. So, in addition to providing the items specifically listed in this letter, please re-review the records of the bank to determine if there are more documents responsive to the two subpocnas. I have enclosed another Certification of Business Records to authenticate and records that you produce in response to this letter. Please send the Certification and the records to Special Agent E. Nesbitt Kuyrkendall, Federal Bureau of Investigation, 505 South Flagler Avenue, Suite 500, West Palm Beach, FL 33401. If you have any questions, please feel free to contact me at 561 209-1047. Thank you for your assistance. Sincerely, R. ALEXANDER ACOSTA UNITED STATES ATTORNEY g By: A. MARIE VILLAFANA Assistant United States Attorney SDNY_GM_027 71795 SUBJECT TO PROTECTIVE ORDER PARAGRAPHS 7, 8, 9, 10, 15, and 17 EFTA_00258603 EFTA01338107  UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF FLORIDA IN RE FEDERAL GRAND JURY SUBPOENAS OLY-01 AND OLY-28 ADDRESSED TO COLONIAL BANK CERTIFICATION REGARDING DOMESTIC RECORDS OF REGULARLY CONDUCTED ACTIVITY I, the undersigned, , declare that I am employed by Colonial Bank in the position of and, by reason of my I position, am authorized and qualified to make this declaration. I. In my employment with Colonial Bank, I am familiar with the business records it maintains. 2. 1 certify that the records attached to this certification: (a) were made at or near the time of the occurrence of the matters set forth therein, by or from information transmitted by, a person with knowledge of those matters; (b) were kept in the course of regularly conducted business activity; and (c) were made by the regularly conducted activity as a regular practice. 2. Among the records so maintained are the attached records itemized in Appendix A (Document Inventory). 3. I further certify that the documents attached hereto are responsive to the Grand Jury Page 1 of 2 SDNY_GM_02771796 SUBJECT TO PROTECTIVE ORDER PARAGRAPHS 7, 8, 9, 10, 15, and 17 EFTA_00258604 EFTA01338108  Subpoenas served upon Colonial Bank. 4. 1 further certify that Colonial Bank has no documents responsive to request number in Grand Jury Subpoena number . [Fill in or strike out as appropriate.] Pursuant to 28 U.S.C. § 1746, I declare under penalty of perjury that the foregoing information is true and correct. Executed this day of , 2007. Place of execution: Signature Page 2 of 2 SDNY_GM_02771797 SUBJECT TO PROTECTIVE ORDER PARAGRAPHS 7, 8, 9, 10, 15, and 17 EFTA_00258605 EFTA01338109  APPENDIX A DOCUMENT INVENTORY The documents submitted are as follows: Signature of Records Custodian: SDNY_GM_02771798 SUBJECT TO PROTECTIVE ORDER PARAGRAPHS 7, 8, 9, 10, 15, and 17 EFTA 00255606 EFTA01338110 06/19/2007 14:39 FAX 5618021787 USAO WPB FL 2,001 • sgs TX REPORT sts TRANSMISSION OK TX/RX NO 4930 CONNECTION TEL 12054028086 SUBADDRESS CONNECTION II) ST. TIME 06/19 14:38 USAGE T 00'55 PCS. SENT 8 RESULT OK U.S. Department of Justice United States Attorney Southern District of Florida A. Mane YillalcuTa 500 S. Australian Ave, 4th Floor West Palm Beach. Florida 33401 (561) 820-8711 Facsimile (561) 820-8777 FACSIMILE COVER SHEET TO: Colonial Bank, attn: Anita Muller DATE: June 19 2007 FAX NO. 205-402-8086 # OF PAGES: PHONE NO. RE: Grand Jury Subpoenas OLY-01 & OLY-28 FROM: A. MARIE VILLAFANA, AssistantU.S. Att PHONE NO. 561 209-1047 COMMENTS: SDNY_GM_02771799 SUBJECT TO PROTECTIVE ORDER PARAGRAPHS 7, 8, 9, 10, 15, and 17 EFTA_00258607 EFTA01338111  U.S. Department of Justice United States Attorney Southern District ofFlorida A. Marie Malaga 500 S. Australian Ave, 4th Floor West Palm Beach. Florida 3340! (560820-8711 Facsimile (561)810-8777 FACSIMILE COVER SHEET TO: Colonial Bank, attn: Anita Muller DATE: June 19, 2007 FAX NO. 205-402-8086 II OF PAGES: (-7 PHONE NO. RE: Grand Jury Subpoenas O1,V-01 & O1,V-28 FROM: A. MARIE. VII.LAFASA, Assistant U.S. Attorney PHONE NO. 561 209-1047 COMMENTS: SDNY_GM_02771800 SUBJECT TO PROTECTIVE ORDER PARAGRAPHS 7, 8, 9, 10, 15, and 17 EFTA_00258608 EFTA01338112  United States District Court SOUTHERN DISTRICT OF FLORIDA TO: COLONIAL BANK SUBPOENA TO TESTIFY Attn: Anita Muller Research Department BEFORE GRAND JURY 1853 Data Drive FGJ 05-02(WPB)-Fri./No. OLY-01 Hoover, AL 35243 Fax: (205) 402-8086 SUBPOENA FOR: nPER.. DOCUMENTS OR OBJECT'S' YOU ARE HEREBY COMMANDED to appear and testify before the Grand Jury of the United States District Court at the place, date and time specified below. PLACE: ROOM: Palm Beach County Courthouse Room 4-A Juvenile Courts Building 205 N. Dixie Highway DATE AND TIME: West Palm Beach, Florida 33401 August 18, 2006 (Temporary location for the United States District Courthouse, West Palm Beach) 9:00am YOU ARE ALSO COMMANDED to bring with you the following document(s) or object(s): All applications, signature cards, credit or background investigations conducted, and correspondence related to Jeffrey Epstein, Sarah Kellen, Nada tor Nadia] Marcinkova, Janusz Banasiak, Adriana Mucinska, Alfredo Rodriguez, and/or VISA Account Number 4470115340008274. For the period of January 1, 2004 to the present, all monthly billing statements, individual charge invoices, repayment records disclosing the dates, amounts, and method of repayment, and checks used to make repayments (front and back) for VISA Account Number 4470115340008274. Please coordinate your compliance of this subpoena and confirm the date and time of your appearance with Special Agent Nesbitt Kuyrkendall, Federal Bureau of Investigation, Telephone: (561) 822-5946. O Please see additional information on reverse This subpoena shall remain in effect until you are granted leave to depart by the court or by an officer acting on behalf of the court. s Oa-""• .4,;:: \ CLERK o DATE: August 2, 2006 (BY) DEPUTY CLERK This subpoena is issued upon application Name, Address and Phone Number of Assistant U.S. Attorney of the U Statetof America Ann Marie C. Villafafia, Assistant U.S. Attorney 500 So. Australian Avenue, Suite 400 West Palm Beach, FL 33401-6235 Tel: (561) 820-8711 x3047 Fax: (561) 802-1787 •It not applicable. enter "none Yob< red ow. orno FORM 0RD-227 SDNY_GM_02771801 SUBJECT TO PROTECTIVE ORDER PARAGRAPHS 7, 8, 9, 10, 15, and 17 EFTA_00258609 EFTA01338113  SAN 86 , RETURN OF SERVICE' RECEIVED DATE (4 3/ 04 PLAC7.thr ip oi m. (30,,vcA s , ....-( BY SERVER SERVED DATE PLACE H ower a . / C th AI VeSet) SERVED ON (NAME) O p /0 A./ t 19 /_, CRCLAJC ( 1A-A.4-4/6 A I Li i-e r- ) SERVED BY TITLE It Isto ski 2 Sid -a -- 17BI , C41— STATEMENT OF SERVICE FEES TRAVEL SERVICES TOTAL DECLARATION OF SERVICE: I declare under penalty of penury under the laws of the Untied States of AMOCO that the foregoing infommtiOn contained in the Return of Service and Statement of Service Fees is true and correct. Executed on 06:66/ 0 4, DA Signature of Sery Address of Server ADDITIONAL INFORMATION 1.As to who may serve a subpoena and the manner of Its service see Rule 17(d). Federal Rules of Criminal Procedure, or Rule 45(c), Federal Rules of Civil Procedure. 2."Fees and mileage need not be tendered to the witness upon service of a subpoena issued on behalf of the United States or an officer or agency thereof (Rule 45(c), Federal Rules of Civil Procedure; Rule 17(d), Federal Rules of Criminal Procedure) or on behalf of certain indigent parties and criminal defendants who are unable to pay such costs (28 USC 1825, Rule 17(b) Federal Rules of Criminal Procedure)" SDNY_GM_02771802 SUBJECT TO PROTECTIVE ORDER PARAGRAPHS 7, 8, 9, 10, 15, and 17 EFTA_00258610 EFTA01338114  United States District Court SOUTHERN DISTRICT OF FLORIDA TO: COLONIAL BANK SUBPOENA TO TESTIFY Attn: Anita Muller Research Department BEFORE GRAND JURY 1853 Data Drive FGJ 05-02(WPB)-Fri./No. OLY-0 1 Hoover, AL 35243 Fax: (205) 402-8086 SUBPOENA FOR: n PERSON X DOCUMENTS OR OBJECT'S' YOU ARE HEREBY COMMANDED to appear and testify before the Grand Jury of the United States District Court at the place, date and time specified below. PLACE: ROOM: Palm Beach County Courthouse Room 4-A Juvenile Courts Building 205 N. Dixie Highway DATE AND TIME: West Palm Beach, Florida 33401 August 18, 2006 (Temporary location for the United States District Courthouse, West Palm Beach) 9:00am YOU ARE ALSO COMMANDED to bring with you the following document(s) or object(s): All applications, signature cards, credit or background investigations conducted, and correspondence related to Jeffrey Epstein, Sarah Kellen, Nada [or Nadia] Marcinkova, Janusz Banaslak, Adriana Mucinska, Alfredo Rodriguez, and/or VISA Account Number 4470115340008274. For the period of January 1, 2004 to the present, all monthly billing statements, individual charge invoices, repayment records disclosing the dates, amounts, and method of repayment, and checks used to make repayments (front and back) for VISA Account Number 4470115340008274. Please coordinate your compliance of this subpoena and confirm the date and time of your appearance with Special Agent Nesbitt Kuyrkendall, Federal Bureau of Investigation, Telephone: (561) 822-5946. ❑ Please see additional information on reverse This subpoena shall remain in effect until you are granted leave to depart by the court or by an officer acting on behalf of the court. This subpoena is issued upon application Name, Address and Phone Number of Assistant U.S. Attorney of the Uaif£d State of America Ann Marie C. Villafana, Assistant U.S. Attorney 500 So. Australian Avenue, Suite 400 West Palm Beach, FL 33401-6235 Tel: (561) 820.8711 x3047 Fax: (561) 802-1787 •11not applicable. Wet •none. iota asal:lir. MAW io FORM ORD-227 SDNY_GM_02771803 SUBJECT TO PROTECTIVE ORDER PARAGRAPHS 7, 8, 9, 10, 15, and 17 EFTA_00258611 EFTA01338115  JAN.86 . . . RETURN OF SERVICE' RECEIVED DATE 094 3/ 0 PLACta eche). , , BY SERVER r( SERVED DATEcei oei ce PLACE h i CPPte....r- 1 ck.. CU/4 //AK) SERVED ON (NAME) Co / 0 Air el L (gcc..,..X ( /4- 714/4,- A ulte r ) SERVED BY TITLE I1 kaki (P 51 O.."-c-f- 114 , :5tC.-4,41- 48 -t41 - STATEMENT OF SERVICE FEES TRAVEL SERVICES TOTAL DECLARATION OF SERVICE' I declare under penalty of perjury under the laws of the United States of America that the foregoing information contained in the Return of Service and Statement of Service Fees is his and correct. Executed on Ogail 0 C. DA Signature of Sent Address of Server ADDITIONAL INFORMATION 1.As to who may serve a subpoena and the manner of Its service see Rule 17(d). Federal Rules of Criminal Procedure, or Rule 45(c), Federal Rules of Civil Procedure. 2."Fees and mileage need not be tendered to the witness upon service of a subpoena issued on behalf of the United States or an officer or agency thereof (Rule 45(c), Federal Rules of Civil Procedure; Rule 17(d), Federal Rules of Criminal Procedure) or on behalf of certain indigent parties and criminal defendants who are unable to pay such costs (28 USC 1825, Rule 17(b) Federal Rules of Criminal Procedure)" SDNY_GM_027718414 SUBJECT TO PROTECTIVE ORDER PARAGRAPHS 7, 8, 9, 10, 15, and 17 EFTA 00255612 EFTA01338116 U.S. Department of Justice Request for Financial Information (Authorization, Washington, D.C. 20530 Purchase Order, Receiving Report) US ken shall only be ISM ram renewing faunal records of irdividuals one partnerships of five or Inter Odieduals. I Purchase Order Numbcr/DCN*: 2 Date Order Prepared. 13 Case Number. (Optional) 08102/2006 FGJ 05.02(WPB) N0.051-01 (01-Y-01) Section A - Authorization and Purchase Order 4 Names and Adds= of Financial Institution: Attn.: Anita Muller, Research Dept. Colonial Bank, 1853 Data Drive, Hoover, AL 35243 - Fax 205-402-8086 5 Deliver To: Special Agent Nesbkt Kuyrkendall, Federal Bureau of Investigation, 505 South Flagier Drive, 6 Return Date Suite 500, Florida 33401, Tel.: (561) 833-7517 08/18/2006 7 Ranks FOR REIMBURSEMENT PLEASE RETURN THIS FORM, THE RECORD OF SERVICES, AND A COPY OF THE SUBPOENA. 8 Name of Requestor: (Type or Print) 9 Tekithone Number 10 Date of request: Ann Marie C. Villafana, AESA (561) 8204711 08/02/2006 Section B - Financial Institution Invoice No Payment Snail Be Made Unless Expenses Are Itemized Below Or On Your Form To Be Attached. II Service/Financial Records Provided: Quantity Amount Utut Price Cost Per Please note that reimbursement cannot be made for the records pertaining to 0.25 Copy corporations or large partnerships of six or more. IMPORTANT: The IDCIA Mandates the use of EFT/DD. In order to receive payment complete the attached EFT enrollment Form. 11.00 Hour Clerical Tech 17.00 Hour Manager or Supervisor (so not proceed with compiling: If cost will exceed $300 without prior approval of Assistant U.S. Attorney/Budget Officer. PLEASE REFERENCE THE ABOVE DC744 ON YOUR INVOICE FOR PAYMENT. 12a Signature of Financial Institution Official: I 2b Plume of Financial Institution Official: 13 Date Signed: Total Amount Claimed By Financial Institution If. Disallowance Section C - Receiving Report (Set Attached) 14 I certify that the ankles and services listed were received: 17 Net to 15 Date Received: Financial Institution IS Right to Financial Privacy Act - Public Law 95-630 19 Signature of Approval Offic 1: (12 U.S.C. 3401-3422) Request Pursuant To: (Check One 04) OBJECT SECTION CLASS O 3404 Customer Authorization 2540 20 Ar•,amting O 3405 Administrative Subpoena or Summons 2541 fC 2 3 4 5 rrew O 3406 Search Wanant 2540 O 3407 Judicial Subpoena 2540 O 3408 Fenno] Written Request O 0 O 3413 I Grand Jury Subpoena C 1.1 21 Schedule and Voucher Number: 3414 Special Procedures 2540 DCO 22 RU11811(5: Funds Available Date I Fans OB011 Budget Officer J APR 64 Mac lam was ekarmically prodtced by Elie Federal Fame. Inc Page i of 3 SDNY_GM02771805 SUBJECT TO PROTECTIVE ORDER PARAGRAPHS 7, 8, 9, 10, 15, and 17 EFTA_002586 I 3 EFTA01338117  GENERAL This is a multi-purpose form designed to sere as an Authorization. Purchase Order, Itemized Invoice. remixing Report and Payment voucher in conjunction with - requests for financial information." pursuant to the Right to Financial Privacy Act of 1978, Pl. 95-630, Title XL, 12 C.S.C. 3415. NOTE: Payments under this purchase order will be due on the 3O calendar day after the date of actual receipt of a proper ins oice in the office designated to receive the invoice. The Prompt Payment Act, Public law 97-177, 96 Stat. 85 (31 C.S.C. 180), is applicable to pay ments under this purchase order and requires the payment to contractors of interest or en «due payments and improperly taken discounts. Determination of interest due will be made in accordance with the pros ision of the Prompt Payment Act and the Office of Management and Budge Circular A-I 25. PREPARATION INSTRUCTIONS ITEM I - A Purchase Order Number will be preprinted on each coml. This number will be used for reference purposes on any correspondence relating to this specific request for financial information. ITEM 2 - Self explanatory. ITEM 3 - This block may be used to identifythe specific case for which the financial information is required. This block may be len blank. SECTION A - AUTHORIZATION AND PURCHASE ORDER (To be completed by the requesting official). ITEM 1 - Enter the name and mailing address of the financial institution being requested to furnish fmmciai infonnation. ITEM 5 - Enter the and address to which the financial information is Lobe sent by the financial institution. This will normally be the name and the addressor the requesting official. ITEM 6 Enter the date the financial information is required. 1 ITEM 7 - Include. if appropriate, any pertinent information related to the purchase order not Fronded for elsewhere on the form ITEM 8.9 and 10 - Self.explanatory. SECTION B - FINANCIAL INSTITUTION INVOICE fro be completed by the financial institution). ITEM I I - Self-explanatory. Completion alibis block constitutes an itemized bill or invoice for reimbursement for the costs incurred in providing the information requested. The DCIA Mandates the use of EFT/DD. b order to receive payment complete the attached EFT enrollment Form. ITEM I2 and 13 - Self-explanatory. SECTION C RECEIVING REPORT (To be completed by the requesting official. what the requested ❑nancial information has been delivered). ITEM 14 and IS Sellexplanatory. ITEM 16 - This block should be used to reflect any differences between the amount claimed by the financial institution and the correct amount to be reimbursed. Differences may result form computation errors, or failure of the financial institution to deliver information requested. ITEM 17 - Enter the amount certified to be proper for payment. ITEM IS - Check the box which identifies the appropriate procedure authorized by the Act, which necessitates the request for financial information. ITEM 19 and 20 These blocks must be signed and dated by an official of the organization whose funds will be charged. His or her signature constitutes a statement that the records to which the invoice refers were required for official business and were pronded by the financial institution in accordance with the ordering instrurrent. ITEM 21 - The Schedule and Voucher Number will be entered by the office which actually schedules the approved amount for payment by the Treasury Department. ITEM 22 - Enter, if appropriate. any data not provided for elsewhere on the recerong report, such as, reasons for any claim amounts disallowed. FORM ORD.21I APR. 51 Nee 2 of SDNYGM02771806 SUBJECT TO PROTECTIVE ORDER PARAGRAPHS 7, 8, 9, 10, 15, and 17 EFTA 00258614 EFTA01338118  VENDOR ELECTRONIC FUNDS TRANSFER (EFT) ENROLLMENT FORM Please comply to this information if you have not done so already PAYEEICOMPANY INFORMATION: Vendor Company Name: Address: Taxpayer ID Number Contact Person Name Telephone Number E-mail Address (If you would like to be notified via e-maa) FINANCIAL INSTITUTION INFORMATION: Bank Name Bank Address Bank Phone Number Nine Digit ABA Routing Transit Number Type of Account (Checking or Saving) Depositor Account Number Signature of Vendor's Authorizing Official Name E. Title of Authorizing Official Please Return or Fax to: U.S. Attorney's Office Southern District of Florida 99 NE 4 street, Suite 200 Miami, FL. 33132 Attention: Claudia Castellanos Fax Number. 305-530-7679 The Debt Collection Improvement Actof 1996 requires that payments made by the Federal government, including vendor payments, must be made by electronic funds transfer (EFT). A benefit of receiving payments by EFT is that your funds are directly deposited to your account at a financial institution and are available to you on the date of payment. If you have questions regarding the delivery of the remittance information, please contact the financial institution where your account is held. If you have any questions on the completion of this form. please contact Claudia Castellanos. at 305-961.9254. FORM 080-211 APR. 64 Pate 3 of SDNY_GM02771807 SUBJECT TO PROTECTIVE ORDER PARAGRAPHS 7, 8, 9, 10, 15, and 17 EFTA_002586 I 5 EFTA01338119 U.S. Department of Justice Request for Financial Information (Authorization, Washington, D.C. 20530 Purchase Order, Receiving Report) This kmMa cely be used Mat requesting financial records of 'eddied/a sad peeterneeldoe of five or one, irdimdals. I Purchase Order Rumba/WNW. 2 Date Order Prepared: 3 Case Number (Optional) 11011-1960 08.0212006 FGJ 05-020VPIB NO.051-01 (01 V.01) Section A - Authorization and Purchase Order 4 Names and Address of Financial Instituuon: Attn.: Anita Muller, Research Dept. Colonial Bank, 1853 Data Drive, Hoover, AL 35243 - Fax 205-402-8086 5 Deliver To. Special Agent Nesbitt Kuyrkendall, Federal Bureau of Investigation, 505 South Flagler Drive, 6 Return Date Suite 500, Florida 33401, Tel.: (561)11334517 08/18/2006 7 Remarks: FOR REIMBURSEMENT PLEASE RETURN THIS FORM. THE RECORD OF SERVICES. AND A COPY OF THE SUBPOENA. 8 Name of Rcqucstor: (Type or Print) 9 Telephone Numba: 10 Date of request: Ann Marie C. Villafana, AUSA (561)820-8711 08/02/2006 Section B - Financial Institution Invoice So Parma Shall Bc Made Unless Expenses Am Itemized Below Or On Your Form To Be Attached. II Service/Financial Records Provided: Quantity Amount Unit Mee Cost Per Please note that reimbursement cannot be made for the records pertaining to 0.25 Copy corporations or large partnerships of six or more. IMPORTANT: The DCIA Mandates the use of EFT/DD. In order to receive payment complete the attached EFT enrollment Form. 11.00 Your Clerical Tech 17.00 Hour Manager or Supervisor Do not proceed with compliance: If cost will exceed 5300 without prior approval of Assistant U.S. Attorney/Budget Meer. PLEASE REFERENCE. THE ABOVE DON ON YOUR INVOICE FOR PAYMENT. 12a Signature of Financial Institution Official: 12b Phone of Financial Institution Official: I3 Date Signed: Total Amount Chimed By Financial Institution 16 Disallowance Section C - Receiving Report (See Attached) 14 I catty that the articles and service listed were received: 17 Nell° 15 Dare Received: Financial Institution IS Right to Financial Pnvacy Act - Public Law 95-630 19 Signature of Approval Official: (12 US.C. 34013422) Request PuisuantTa (Check One 04) OBJECT SECTION CLASS O 3404 Customer Authorization 2540 20 O 3405 Administrative Subpoena or Summons 2541 TY rc 1 2 3 4 S PROJ O 3406 Search Warrant 2540 O 3407 Judicial Subpoena 2540 03408 Formal Written Ravel; 2540 O 3413 I Grand Jury Subpoena 2.545 21 Schedule and Voucher Number: O 3414 Special Procedures 2540 Da/ 22 Remarks: El Funds Available Date I