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Name

Street
City, State
(XXX) 864-FONE

UNITED STATES DISTRICT COURT


FOR THE EASTERN DISTRICT OF CALIFORNIA

In the Matter of the Search of: ) IN ADMIRALTY


)
) Case No. <warrant no.>
) SEARCH WARRANT
)
) VERIFIED CLAIM TO PROPERTY
<description of seized property> ) IN REM SEIZURE ON LAND
[make a list here of all property )
against which warrant is issued] ) RESTRICTED APPEARANCE
) Rule E(8)

[Name of property owner], intervening for the interest of himself and as trustee of

[NAME] TRUST, makes claim before this Court to the property arrested from captioned

location by [NAME], Supervisory Sp. Agent, [NAME], Special Agent and [NAME] and

from USBank accounts [NUMBER] and [NUMBER] by [NAME], Territory Manager

allegedly for Department of the Treasury Internal Revenue Service. [Name of property

owner] makes claim to the property, avers that at the time of the seizure of the property

he was, and still is, entitled to sole possession and is bone fide legal owner, of such
property and that no other person is entitled to possession or has made a verified claim as

to any interest held in said property.

Notice is given that [Name of property owner] appears specially in this action

under Supplemental Admiralty Rule E(8), Federal Rules of Civil Procedure, for the sole

purpose of defending against any claim of {NAME OF AGENT], [NAME OF AGENT],

[NAME OF AGENT], or the Department of the Treasury Internal Revenue Service in the

above entitled action, with respect to which claim there has been process of seizure, and

this appearance is expressly restricted to the defense of such claim and does not constitute

an appearance for the purpose of any other claim or claims. Claimant demands

restitution and return of the property and hereby claims this property and the right to

defend this property on behalf of himself and said trust.

Dated June 6, 2001.

Respectfully submitted,

By: _________________________________
[Name of owner of property]

VERIFICATION

I, [Name of Owner], declare as follows based on my personal knowledge:

1. I am a duly authorized an bona fide Trustee of [NAME] TRUST.

2. I have read the foregoing VERIFIED CLAIM TO PROPERTYY,K IN REM

SEIZURE ON LAND – RESTRICTED APPEARANCE, know the contents thereof,

and believe the same to be true.


3. I am authorized to make this verification on behalf of myself and the [NAME]

TRUST.

4. I am unaware of any other verified claim or affidaviyt supporting an in rem seizure on

land.

5. I am unaware of the nature and cause of action.

6. I am aware of no exigent circumstances of this seizure without a pre-seizure hearing.

7. I am unaware of any pre-seizure hearing.

8. I am unaware of any post-seizure hearing.

9. I am holder in due course and secured party for [NAME] TRUST.

10. I am unaware of any demand for return of money or collection action.

11. To the best of my knowledge I have acted in good faith and with full and adequate

disclosure of my activities and my duties to disclose and pay taxes as I know them to

exist.

[THIS IS ONLY AN EXAMPLE – IT MUST NOT BE USED VERBATIM. EACH


CIRCUMSTANCE WILL DIFFER]

I declare under penalties of perjury that the foregoing is true and correct.

Executed this ____ day of June 2001.

[Name of property owner making the claim]