SUBPOENA DUCES TECUM
UNITED STATES OF AMERICA
DEPARTMENT OF LABOR
Employee Benefits Security Administration
To (Name of Individual) and/or (Name of Plan, Corporation or Entity)
Custodian of Records
You are hereby required to appear before
of the Employee Benefits Security Administration, U.S. Department of Labor, at
in the City of
on the day of at o'clock of that day, in the Matter of a criminal investigation involving (name of plan)
being conducted pursuant to Section 504(a) and 506(b) of the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. Sections 1134(a) and 1136(b), in order to determine whether any person has violated or is about to violate any provision of Title I of ERISA, and to detect and investigate and refer where appropriate, civil and criminal violations related to the provisions of Title I of ERISA and other related Federal laws, including the detection, investigation, and appropriate referrals of related violations of Title 18 of the United States Code.
And you are hereby required to bring with you and produce at said time and place the following books, records and documents:
This subpoena is issued under the authority provided in Section 504(c) of ERISA, 29 U.S.C. Section 1134(c) and 15 U.S.C. Sections 49 and 50. In the case of disobedience to a subpoena the Secretary may invoke the aid of any district court of the United States in requiring the attendance and testimony of witnesses and the production of documentary evidence pursuant to15 U.S.C. 49.
In testimony whereof I have hereunto affixed my signature
and the seal of the United States Department of Labor
at .
this day of ,
Regional Director
EBSA 200CR (Rev. 06-13)
Return of Service
I hereby certify that the original of the within subpoena was duly served on the person named herein.
(Check method used)
in person
by certified or registered mail
other (specify)_____
by leaving at principal office
or place of business, to wit:
on
(Month, day, year)
(Name of person making service)
(Official Title)