Page 581 - Trump Executive Orders 2017-2021

10284 Federal Register / Vol. 83, No. 46 / Thursday, March 8, 2018 / Presidential Documents

(United States) (finance officer at_) ) in the amount of$ for (private
property alleged to have been (lost) (destroyed) in the military service) ( , which
claim was (false) (fraudulent) (false and fraudulent) in the amount of in that __
_
and was then known by the said to be (false) (fraudulent) (false and fraudulent).
(2) Presenting false claim.
In that (personal jurisdiction data), did, (at/on board-location)
(subject-matter jurisdiction data, if required), on or about 20_, by presenting (a
voucher) ( ) to , an officer of the United States duly authorized to (approve) (pay)
(approve and pay) such claim, present for (approval) (payment) (approval and payment) a claim
against the (United States) (finance officer at ( in the amount of
$ for (services alleged to have been rendered to the United States by ____ _
during which claim was (false) (fraudulent) (false and fraudulent)
in the amount of in that and was then known by the said to be
(false) (fraudulent) (false and fraudulent).
(3) Making or usingfalse writing.
In that (personal jurisdiction data), for the purpose of obtaining the
(approval) (allowance) (payment) (approval, allowance, and payment) of a claim against the
United States in the amount of did (at/on board-location) (subject-matter jurisdiction
data, if required), on or about 20 (make) (use) (make and use) a certain (writing)
(paper), to wit: , which said (writing) (paper), as (he) (she), the said , then
knew, contained a statement that , which statement was (false) (fraudulent) (false
and fraudulent) in that and was then known by the said to be (false)
(fraudulent) (false and fraudulent).
( 4) Making fal<se oath.
In that (personal jurisdiction data), for the purpose of obtaining the
(approval) (allowance) (payment) (approval, allowance, and payment) of a claim against the
United States, did (at/on board-location) (subject-matter jurisdiction data, if required), on or
,
about 20 __ make an oath (to the fact that (to a certain (writing)
(paper), to wit: to the effect that , which said oath was false in
that , and was then known by the said to be false.
(5) Forging or counterfeiting signature.
In that (personal jurisdiction data), for the purpose of obtaining the
(approval) (allowance) (payment) (approval, allowance, and payment) of a claim against the
United States, did (at/on board-location) (subject-matter jurisdiction data, if required), on or
about 20 __ (forge) (counterfeit) (forge and counterfeit) the signature of __ _
,
upon a in words and figures as follows: ___ _
(6) Using forged signature.
In that (personal jurisdiction data), for the purpose of obtaining the
(approval) (allowance) (payment) (approval, allowance, and payment) of a claim against the
United States, did (at/on board-location) (subject-matter jurisdiction data, if required), on or
about 20 __ use the signature of on a certain (writing) (paper), to wit:
,
____ ,then knowing such signature to be (forged) (counterfeited) (forged and
counterfeited).
(7) Paying amount less than called for by a receipt.
In that (personal jurisdiction data), having (charge) (possession)
sradovich on DSK3GMQ082PROD with PRES DOCS VerDate Sep<11>2014 18:39 Mar 07, 2018 Jkt 244001 PO 00000 Frm 00398 Fmt 4705 Sfmt 4790 E:\FR\FM\08MRE0.SGM 08MRE0 ER08MR18.400</GPH>
of the United States, (furnished) (intended) (furnished
(custody) (control) of (money)

379