|
|
|
|
|
To: <name and address of financial institution>
|
|
From: <name of regional director>
U.S. Department of Labor
Pension and Welfare Benefits Administration
<address>
|
|
I hereby certify that the applicable provisions of the Right to Financial
Privacy Act of 1978, 12 U.S.C. §§3401-3422, have been complied with as to
the subpoena presented on <date> for the following financial records
of <name>:
|
|
Regional Director
U.S. Department of Labor
Pension and Welfare Benefits Administration
<address>
<telephone number>
<date>
|
|
Pursuant to the Right to Financial Privacy Act of 1978,
good faith reliance upon this certificate relieves your institution and its
employees and agents of any possible liability to the customer in connection
with the disclosure of these financial records.
|
