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This is an FBI investigation document from the Epstein Files collection (FBI VOL00009). Text has been machine-extracted from the original PDF file. Search more documents →

FBI VOL00009

EFTA01075176

162 pages
Pages 41–60 / 162
Page 41 / 162
Pitted States District " loud 
SOUTHERN DISTRICT OF FLORIDA 
TO: 
SUBPOENA TO TESTIFY 
BEFORE GRAND JURY 
FGJ 05-02(WPB)-Fri./No. OLY-13 
• 
SUBPOENA FOR: 
PERSON 
pi DOCUMENTS OR OBJECT[S] 
X 
1,3 
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: 
Palm Beach County Courthouse 
Juvenile Courts Building 
205 N. Dixie Highway 
West Palm Beach, Florida 33401 
(Temporary location for the United States District Courthouse, West Palm Beach) 
ROOM: 
Room 4-A 
DATE AND TIME: 
September 8, 2006 
11:00am 
YOU ARE ALSO COMMANDED to bring with you the following document(s) or object(s): 
Please coordinate your compliance of this subpoena and confirm the date and time of your 
appearance with Special Agent' 
'Federal Bureau of Investigation, 
Telephone:I 
b3 
b6 
b7C 
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. 
CLERK 
(BY) DEPUTY CLERK 
O 
pits Otaro 
le.e. 
DATE: 
September 1, 2006 
This subpoena is issued upon application 
of the United States of America 
*If not applicable, enter 'none.' 
me, A4 ess 
Number of Assistant U.S. Attorney 
 
 Assistant U.S. Attorney 
500 So. Australianrem; Suite 400 
West Palm Beach, L 33401-6235 
Tel: 
Fax: 
316., 
w  Fot o&
A-
To be =disks of A0110 
EFTA01075216
Page 42 / 162
JAN.86 
IP 
IIIP 
RETURN OF SERVICE' 
RECEIVED 
BY SERVER 
DATE / 
1 
0 (1/0// 0 4 
PLACE 
 J
a
c-- 4
1/4\ 
ve?„..C2 v,a  3 ...ti  crt 
\- 
SERVED 
DATE / 
/ 
0 410 I/0 te 
- 
PLACE 
(
I  'e sk 
B'\
Y1-• ttl29-3
\ 
F.  C -
/ 
SERVED ON (NAME) 
b3 
SER 
TITLE 
S 
e Csck0 
. ev\--\---
STATEMENT OF SERVICE FEES 
TRAVEL 
SERVICES 
TOTAL 
b6 
b7C 
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 true and correct. 
Executed on 
6 40(O i 
DA 
' 
gbc. 
S. FlOtielZa
r (J
4 t.S-0t 
(Al PAz R-
Address of Server 
ADDITIONAL INFORMATION 
• 
1.M to who may serve a subpoena and the manner of its service see Rule 17(d). Federal Rules of Criminal Procedure, or 
Rule 45(e), 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(e), 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)" 
EFTA01075217
Page 43 / 162
Untied States District Cat 
SOUTHERN DISTRICT OF FLORIDA 
TO: 
SUBPOENA TO TESTIFY 
BEFORE GRAND JURY 
FGJ 05-02(WPB)-Fri./No. OLY-13/2 
SUBPOENA FOR: 
PERSON 
b3 
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: 
Fourth District Court of Appeals 
1525 Palm Beach Lakes Boulevard 
West Palm Beach, Florida 33401 
(Temporarilocation for the United States District Courthouse, West Palm Beach) 
ROOM: 
Courtroom 
DATE AND TIME: 
October 27, 2006 
1:00pm 
YOU ARE ALSO COMMANDED to bring with you the following document(s) or object(s): 
b3 
Please coordinate your compliance with this subpoena and confirm the date and time of 
your appearance with Special Agent I 
 Immigration and Customs 
Enforcement, Telephone: 
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. 
b6 
b7C 
DATE: 
October 19, 2006 
This subpoena is issued upon application 
of the United States oEAmeica 
If not applicable, enter "none? 
Name, Address and Phone Number of Assistant U.S. Attorney 
Assistant U.S. Attorney 
500 So. Australian Avenue, Suite 400 
West Palm Beach, FL 33401-6235 
Tel: 
Fax: 
To be used In lieu ofA0110 
FORM ORD-R7s d3 
3 1E- MN- / oro lee% 56?-4-2-
EFTA01075218
Page 44 / 162
JAN.86 
IP 
RETURN OF SERVICE,
RECEIVED 
BY SERVER 
DATE 
10/19/06 
s. 
PLACE 
. 
USAO, West Palm Beach, FL 
SERVED 
DATE 10/19/06 
RAC 
SERVED ON (NAME) 
• 
b3 
1._ 
SERVED BY 
TIRE 
Special Agent, DHS/ICE 
. 
STATEMENT OF SERVICE FEES 
TRAVEL 
SERVICES 
TOTAL 
b6 
b7C 
DECLARATION OF SERVICE2
I declare under penalty of penury 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 true and correct. 
Executed on I 0 il 9 /2006 
DATE 
glj 
501 S. Flagler Dr., Ste. 500, WPB, FL 33401 
Address of Server 
ADDITIONAL INFORMATION 
Served in person at 11:09 a.m. 
1.As to who may servo 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 bo tendered to the witness upon service of a subpoena Issued onbehaif 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)" 
lir 
EFTA01075219
Page 45 / 162
te
hc
 States Districtturt 
SOUTHERN DISTRICT OF FLORIDA 
TO: 
SUBPOENA TO TESTIFY 
BEFORE GRAND JURY 
FGJ 05-02(WPB)-Fri./No. OLY-10/2 
b3 
SUBPOENA FOR: 
n 
PERSON 
11 
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: 
Palm Beach County Courthouse 
Juvenile Courts Building 
205 N. Dixie Highway 
West Palm Beach, Florida 33401 
(Temporary location for the United States District Courthouse, West Palm Beach) 
ROOM: 
Room 4-A 
DATE AND TIME: 
September 15, 2006 
9:00am 
YOU ARE ALSO COMMANDED to bring with you the following document(s) or object(s): 
b3 
Please coordinate your compliance  of this subpoena and confirm the date and time of your appearance with 
Special Agents 
'Federal Bureau of Investigation, Telephone:[ 
b6 
. b7C 
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. 
DATE: 
August 28, 2006 
This subpoena is issued upon application 
of the United Statec of America 
in not applicable, enter "none.' 
Name, Address and Phone Number of Assistant U.S. Attorney 
 
!Assistant U.S. Attorney 
500 So. Australian Avenue, Suite 400 
West Palm Beach, FL 33401-6235 
Tel 
Fax: 
To tc Wed le lieu Of AOI10 
FORM ORD•227 
ate- NM_ /0 V:162-6-s 24/ 
EFTA01075220
Page 46 / 162
JAN.86 
• 
- 
RETURN OF SERVICE'  •
BY
RECEIVED 
SERVER 
DAT0Eark sk 
PLACE 
W
e8+7
01 44:P
eestal it FL
SERVED 
DATbikra/ 04
PLACE 
ada 
&
oaf
r 
Cc..:-.L.
I 
SERVED ON (NAP/ 
b3 
SERVED 
TITLE 4-1.28 
I 
....-3;?ecra iL
b6 
b7C 
STATEMENT OF SERVICE FEES 
TRAVEL 
SERVICES 
TOTAL 
DECLARATION OF SERVICE2 
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 
true an correct. 
its 
Executed on UpriteG 
D 
E 
signature or server 
9 '15- 5 
A
rr"Z 
-a3 
— 
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 tho 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)" 
EFTA01075221
Page 47 / 162
This subpoena is issued upon application 
of the United States of America_ 
'S 
TO: 
United States District trurt 
SOUTHERN DISTRICT OF FLORIDA 
SUBPOENA TO TESTIFY 
BEFORE GRAND JURY 
FGJ 05-02(WPB)-Fri./No. OLY-21 
SUBPOENA FOR: 
PERSON 
1,3 
DOCUMENTS OR OBJECTS] 
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: 
United States District Courthouse 
701 Clematis Street 
West Palm Beach, Florida 33401 
ROOM: 
Grand Jury Room 
DATE AND TIME: 
December 1, 2006 
9:30 am 
YOU ARE ALSO COMMANDED to bring with you the following document(s) or object(s): 
Please coordinate your compliance with this subpoena and confirm the date and time of your appearance 
with Special Agent 
Federal Bureau of Investigation, Telephone: I 
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. 
b3 
b6 
b7C 
DATE: 
November 13, 2006 
Name, Address and Phone Number of Assistant U.S. Attorney 
 
assistant U.S. Attorney 
500 So. Australian Avenue, Suite 400 
West Palm Beach FL 39401-6235 
Tel: 
Fax: 
*If not applicable, enter "none." 
To be used in tic. of A0110 
3/5- qe4 /96-vb a-- al-P-2 e'r 4
FORM ORD-227 
JAN.86 
EFTA01075222
Page 48 / 162
S
RETURN OF SERVICE' 
RECEIVED 
BY SERVER 
DATE
/ 
(172-0 (go 
PLACE 
ra 
k - 
Li -FR 
I 
--;__ 
SERVED 
DIAIT t7  / oh
7 
PLACE 
Fre
i 
- 
u
 TA ,Tz ra
1-3 I 
SERVED ON (NAME) 
b3 
SERI 
TITLE 
1 
e_r__,cSi._ d
j--B 
OF SERVICE FEES 
STATEMENT 
TRAVEL 
SERVICES 
b6 
TOTAL 
157e 
DECLARATION OF SERVICE' 
I declare 
Statement 
Executed 
under penalty of perjury under the laws 
of Service Fees Is true and correct. 
on UPI /Z° 0 4.
of the United States of America that the foregoing information contained in the Return of Service and 
D TE 
Signalufa or aervur 
SOS- 
S. 
t 
to? -R 
'Pi__ 
Address of Server 
f 
I 
ADDITIONAL INFORMATION 
1.A3 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)" 
EFTA01075223
Page 49 / 162
fitted States DistrictOourt 
SOUTHERN DISTRICT OF FLORIDA 
TO: 
SUBPOENA TO TESTIFY 
BEFORE GRAND JURY 
FGJ 07-103(WPB)-Tues./No. OLY-37 
SUBPOENA FOR: 
PERSON 
b3 
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: 
United States District Courthouse 
701 Clematis Street 
West Palm Beach, Florida 33401 
ROOM: 
Grand Jury Room 
DATE AND TIME: 
March 27, 2007 
1:00 pm* 
YOU ARE ALSO COMMANDED to bring with you the following document(s) or object(s): 
*Please coordinate your compliance with this subpoena and confirm the date and time , and location of 
your appearance with Special Agent' 
'Federal Bureau of Investigation, Telephone: 
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. 
b3 
136 
b7C 
CLERK 
(BY) DEPUTY CLERK 
This subpoena is issued upon application 
of the United States of America 
DATE: 
March 16, 2007 
/ Name, Ad 
s and Phone Number of Assistant U.S. Attorney 
I 
'Assistant U.S. Attorney 
500 So. Australian Avenue, Suite 400 
West Palm Beach, FL 33401-6235
Tax
Fax: 
9f not applicable, enter "none." 
To beaudio lieu of ACII 10 
FORM ORD-227 
JAN.86 4.saa 
31 gpvvt - I o to 2_41411:3-
EFTA01075224
Page 50 / 162
• 
RETURN OF SERVICE 
0 
RECEIVED 
BY SERVER 
DATE 3/14/07 PLACE 
We-s-i- R an, ge act., , CZ_ 
SERVED 
DATE3 40 
PLACE 
tut t? /fl. 
ge4ce-- 
,ca. 
SERVED ON (NAME) 
(
b3 
TITLE 
Per 
5- 4^ 
SERVED BY 
STATEMENT OF SERVICE FEES 
C TRAVEL 
SERVICES 
b6 
TOTAL 
b7C 
DECLARATION OF SER VICE2
I declare under penalty of perjury under the lam of the United States of America that the foregoing information contained in the Return of Service and 
Statement of Service Fees is true and correct
Executed on 0.740 7 
DA 
Pr 57 4-apntoi 44, rizr....n-p 
"Pc
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)" 
EFTA01075225
Page 51 / 162
lited States Districttourt 
SOUTHERN DISTRICT OF FLORIDA 
TO: 
SUBPOENA TO TESTIFY 
• BEFORE GRAND JURY 
FGJ 07-103(WPB)-Tues./No. OLY-39 
SUBPOENA FOR: • 
b3 
PERSON 
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: 
United States District Courthouse 
701 Clematis Street 
West Palm Beach, Florida 33401 
ROOM: 
Grand Jury Room 
DATE AND TIME: 
April 3, 2007 
1 :00pm* 
YOU ARE ALSO COMMANDED to bring with you the following document(s) or object(s): 
b3 
*Please coordinate your compliance  with this subpoena and confirm the date and time , and location of 
your appearance with Special Agent' 
I, Federal Bureau of Investigation, Telephone: 
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 
of the United States of America 
b6 
Name, Address and Phone Number of Assistant U.S. Attorney 
'Assistant U.S. Attomey 
500 So. Australian Avenue, Suite 400 
West Palm Beach FL 33401-6235
Tel: 
Fax: 
II not applicable, enter none. 
To be ustd b Ike *MOM 
FORM ORD-227 
JAN.86 
3 Lc:-rnrn 
TN 67..: 
EFTA01075226
Page 52 / 162
• 
RETURN OF SERVICE,
II 
RECEIVED 
BY SERVER - 
DATE
O
— 21 rl 
PLACE 
1 ) IP
)  
9_
I
SERVED 
DATE* 
csi
PLACE 
SERVED ON (NAME) 
b3 
I
SERVED BY 
% 
TITLE 
Th r 
/leas
CA 4SCI- 
-NT\--
STATEMENT OF SERVI E FEES 
TRAVEL 
SERVICES 
TOTAL 
b6 
b7C
' 
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 true and correct. 
Executed on 
0 3 
L dol
DATE 
Signature C. 
r 
c>(.
5 
-S . F 1 as(s reps( I\ re- 
ft  Cc._ 
i
Pk:55-2) 
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(e), 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)" 
EFTA01075227
Page 53 / 162
 
• 
United States District Court 
SOUTHERN DISTRICT OF FLORIDA 
TO: 
SUBPOENA TO TESTIFY 
BEFORE GRAND JURY 
FGJ 07-103(WPB)-Tues./No. OLY-29 
SUBPOENA FOR: • 
n
PERSON 
b3 
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: 
United States District Courthouse 
701 Clematis Street 
West Palm Beach, Florida 33401 
ROOM: 
Grand Jury Room 
DATE AND TIME: 
March 6, 2007 
1:00 pm* 
YOU ARE ALSO COMMANDED to bring with you the following document(s) or objebt(s): 
See attachments 
*Please coordinate your compliance with this subpoena and confirm the date and time , and location of 
your appearance with Special Agents 
I Federal Bureau of Investigation, Telephone: 
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. 
(BY) DEPUTY CLERIC 
This subpoena is issued upon application 
of the United States of America 
a 
If not applicable, enter "none." 
DATE 
b6 
b7C 
February 14, 2007 
Name, Address and Phone Number of Assistant U.S. Attorney 
 
'Assistant U.S. Attorney 
500 So. Australian Avenue, Suite 400 
West Palm Beach, FL 33401-6235 
Tel: 
Fax: 
To be used urea of AO110 
FORM ORD-227 
JAN.86 
31E- Ik4fri
/0/060; 
at
EFTA01075228
Page 54 / 162
• 
RETURN OF SERVICE, • 
RECEIVED 
BY SERVER 
DAT 420/01
PLACE t ops
1 
SERVED 
DA6S/051 0
PLACE 
6,/(/A 
fr A)C) 
SERVED ON (NAME
b 3 
SERVED B 
TITLE 
*F-B I 54 
STATEMENT OF SERVICE FEES 
TRAVEL 
SERVICES 
b6 
TOTAL 
b7C 
DECLARATION OF SERVICE2
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 true and correct. 
Executed on 
'3 5 (11 
4 
DA E 
• 
ST)S- - s. tviq_ey- , u?-8 fa 
I, 
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 bo 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)" 
EFTA01075229
Page 55 / 162
• 
• 
b3 
ATTACHMENT TO GRAND JURY SUBPOENA 
FGJ 07-103 OLY-29 
EFTA01075230
Page 56 / 162
U.S. Departn. of Justice 
United States Attorney 
Southern District of Florida 
500 S. Australian Ave., Suite 400 
West Palm Beach, FL 33401-6235 
APPEARANCE NOTICE 
The attached subpoena requires the production of the records specified to a Federal 
Grand Jury/Trial in the Southern District of Florida. 
A new provision of the Federal Rules of Evidence provides that routine business 
records may be admitted at trial through the declaration of a custodian, if they are provided 
sufficiently in advance of trial to allow an opportunity for any challenges to their 
authenticity. Therefore, you may be able to avoid appearing personally at the grand 
jury/trial at the time and place specified by completely filling out the attached Certification 
and Inventory and immediately returning it with the records to Special Agent! 
 
FBI at the following address: 
Federal Bureau of Investigation 
505 South Flagler Drive, Ste. 500 
West Palm Beach, Florida 33401-5923 
EARLY VOLUNTARY TURNOVER 
Please note that we are requesting an early voluntary turnover of the materials 
subpoenaed. The early voluntary turnover date is prior to March 6. 2007. 
BY: 
Sincerely, 
R. ALEXANDER ACOSTA 
UNITED STATES ATTORNEY 
ASSISTANT UNITED STATES ATTORNEY 
b6 
b7C 
EFTA01075231
Page 57 / 162
CERTIFICATION OF BUSINESS RECORDS 
I, the undersigned, 
, declare that I am: 
employed by/associated with 
 in the 
position of 
and by reason of my 
position am authorized and qualified to make this declaration. 
In my employment with the above-named bank/company I am familiar with the 
business records it maintains. The above-named bank/company maintains records of its 
business which are: 
1. 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; 
2. kept in the course of regularly conducted business activity; and 
3. made by the regularly conducted activity as a regular practice. 
Among the records so maintained are the attached records itemized in Appendix A, 
Inventory of Documents. 
I declare under penalty of perjury that the foregoing is true and correct. 
Date of execution: 
Place of execution: 
Signature: 
EFTA01075232
Page 58 / 162
• 
APPENDIX A 
• 
DOCUMENT INVENTORY 
The documents submitted are as follows: 
Signature of Records Custodian: 
EFTA01075233
Page 59 / 162
'Washington, D.C. 20530 
U.S. Department of Justice 
Request for Financial Information (Authorization, 
Purchase Order, Receiving Report) 
This form shall only be toed when removing fluvial records of individuals ad parmersbips of five or fewer individuals. 
1 Purchase Order Number 
2 Date Order Prepared: 
2/14/2007 
3 Case Number: (Optional) 
FGJ 07-103(WPB) No. OLY-29 
4 Name and Address of Financial Institution. 
5 Deliver To: FBI Special Agent) 
Section A - Authorization and Purchase Order 
6 Return Date: 
3/6/2007 
7 Itewanks: 
FOR REIMBURSEMENT PLEASE RETURN THIS FORM, THE RECORD OF 
SERVICES, AND A COPY OF THE SUBPOENA. 
8 Name of Roauestor mine or Prim) 
AUSAI 
i
9 TelerrhoncNomher 
l 10 Date of request: 
2/14/2007 
Section B - Financial Institution Invoice 
No Payment Shall Be Made Unless Expenses Me Itemized Below Or On Your Form ToBe Attached. 
II Senriee/Firtandal Records Provided: 
Quantity 
Unit Price 
Amount 
Cost 
Per 
FOR PROMPT PAYMENT INCLUDE TAX I.D. NUMBER. 
Please note that reimbursement cannot be made for the records pertaining to 
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. 
Do not proceed with compliance: If cost will exceed $500 without prior approval of 
0.25 
11.00 
17.00 
Copy 
Hour Clerical 
Tech 
Hour Manger 
or 
Supervisor 
Budget Office.' 
"Fax any request to (305)530.7679 
12 Signature of Financial Institution Official: 
13 Date Signed: 
Total AmountClaimed 
By Financial Institution 
0.00 
Section C - Receiving Report 
16 Disallowance 
art Attached) 
14 I certify that the articles and semi= listed were received: 
15 Date Received: 
17 Net to 
Financial 
Institution 
III Right to Financial 
(12 U.S.C.3401-3422)Request 
SECTION 
o 
o In 
• 
• 
II 
■ 
Privacy Act - Public Law 95-630 
Pursuant To: (Check One Only) 
OBJECT 
CLASS 
3404 
Customer Authorization 
2540 
3405 
Administrative Subpoena or Summons 
2541 
3406 
Search Warrant 
2542 
3407 
Judicial Subpoma 
2543 
3408 
Formal Written Request 
2544 
3413 I 
Grand Jury Subpoena 
2545 
3414 
Special Procedures 
2546 
19 Signature of Approving Official: 
20 Accounting Classification Code 
FY FCI I 
2 
3 
4 
5 
PROJ 
I 
I 
1 .
1 
11
I 
I 
21 &attic aad YoucherNumbet 
Dal 
22 Re:mks: 
0 
Funds Available 
Date: 
Budget Officer: 
This form was ontroninsiv PC411Otid bf Elio Federal Form. Inc 
0 
FORM OBD-2 I I 
APR BO 
b3 
156 
b7C 
EFTA01075234
Page 60 / 162
• 
GENERAL 
This is a mul ti.purpose form designed to sent as an Authorization, Purchase Oder, Itemized Invoice, ReceivjggRepon and Payment voucher in 
conjunction with "requests for financial information,' pursuant to the Right toFinancial Privacy Act of 1978, 95.630, Tide XI, 12 U.S.C.3415. 
NOTE: 
Payments under this purchase order will be due on the 30th calendar day after the date of actual receipt of n proper InvoiceIn the office designated to receive 
the invoice the date of the check issued in payment shall be considered to be the dale payment is made. 
The Prompt Payment Act, Public Law 97-177,96 Stat 85 (31 U.S.0 180), Is applicable to payments under this purchase order and requires the payment to 
contractors of interest or overdue payments and improperly taken discounts. Determination of interest due will be made in accordance with the provaions of 
the Prompt Payment Act and the Office of Management and Budget Circular A-125. 
PREPARATION INSTRUCTIONS 
ITEM I -A Purchase Order Number will be preprinted on each form This number will be used for reference purposes on any correspondence relating to this sped fic 
request for Muncie! information. 
• 
ITEM 2 - Self explanatory. 
ITEM 3 - This blodc may be used to identify the specific case for which the ftruncial information is required. This blodc may be left blank. 
SECTION A -AUTHORIZATION AND PURCHASE ORDER (To be completed by the requesangofficial). 
ITEM 4 - Enter the name and mailing address of the financial institution behgrequested to furnish fmancial infomutien. 
ITEM 5 - Enter the name and address to which the financial information is to be sent by the financial institution. This will normally be the name and add =sof the 
requesting official. 
ITEM 6 - Enter the date the financial information is required. 
ITEM 7 - Include, if appropriae, any pertinent information related to the punhase order not provided for elmwhere on the form. 
ITEM 8,9 and 10 - Sdf-explanatory. 
SECTION - FINANCIAL INSTITUTION INVOICE (To be completed by the financial indiction). 
ITEM II - Self-explanatory. Completion of this block constitutes an itemized till or invoice for reimbursement for the cons incurred in providing the infomation 
requested. 
ITEM 12 end 13 - Self-explanatory. 
SECTION C - RECEIVING REPORT (To be completed by the requesting official, whenthe requested financial information has been delivered). 
ITEM 14 and I5 Self-explanatory. 
ITEM 16 - This block should be used to reflect any differences between the anion claimed by the financial instkution and the correct amount to be reimbursed 
Differences may result from computation arms, or failure of the financial inlitudon to deliver information requested. 
ITEM 17 - Enter the amount certified to be proper for payment. 
ITEM 18 - Check the box which identifies the appropriate procedure authorized ty the Act, which necessitates the request for financial infarmation. • 
ITEM 19 and 20 -These blocks must be signed and dated by an official of the oganization whose finds will be charged. His or her signature consitutes a staement that the 
records to which the invoice refers were required for official business and were provided by the-financial institution in xcordance with the ordering instnment 
ITEM 2I - The Schedule and Voucher Number will be entered by the office which lewdly schedules the approved amount for payment by the Treasury DepartMent. 
ITEM 22 - Enter, if appropriate, my data not provided for elsewhere on the rettiving report, such as, reasons for any claim amounts disalbwed. 
EFTA01075235
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