Form TD F 92-22.46 TD F 92-22.46 Request for Transfer of Property Seized/Forfeited by a T

OMB No. 1505-0152

DEPARTMENT OF THE TREASURY
Request for Transfer of Property Seized/Forfeited by a Treasury Forfeiture Fund Participating Agency
 All assets transferred must be used in accordance with the U.S. Department of Justice and U.S Department
of the Treasury Guide to Equitable Sharing for State, Local, and Tribal Law Enforcement Agencies.
 The deadline for submission of this request is forty-five (45) days following the forfeiture date of the asset
requested.
 The requesting agency will be responsible for reimbursing the Treasury Forfeiture Fund its costs.

I.

Seizing Agency (For Treasury Forfeiture Fund Participating Agency Use Only)
Seizure Number:

Seizing Agency:

Case Number:

SAC Office:

Case Type:

Adoption

Joint

II. Requesting Agency
Agency Name:
NCIC Code:
Agency is serving as a Fiduciary Agency for Task Force name:
Case Number:
Address:
Contact Person:
Telephone Number:
Email:
III. Asset Requested (If requesting more than one asset, please attach list)

Asset Description:
Request Type: Cash Proceeds

Item

IV. Agency Participation

How many workhours were expended in the seizure/forfeiture of this asset?
Will sharing be based on pre-determined percentage in a Task Force
Agreement that was applicable at the time of the seizure/forfeiture?

Yes

No

If YES, please attach the Memorandum of Understanding/ Agreement.

Summary of Participation to the seizure and forfeiture of the referenced asset:
*****Summary should include information such as who initiated the investigation, did
the requesting agency provide POI/POE payments and the amount, were
extraordinary expenses incurred by the requesting agency (i.e., Pens/Ping orders,
T-III, etc, and any specific assistance (i.e., narcotics K-9, computer forensic
assistance, SRT, etc) that lead to the seizure of the referenced asset*****

TD F 92-22.46 (1/2019) PREVIOUS VERSIONS OBSOLETE

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Continuation of Summary of Agency Participation:

V. Certification by Participating/Fidiciary Agency
Is the agency authorized to submit a request for an equitable sharing of this asset under
No
applicable State law? Yes
A.

I certify that the above information including, but not limited to, the number of workhours
and the narrative contributions to the investigation, are true and accurate statements of this
agency’s activities. I further certify that the funds or property transferred will be used only
for permissible law enforcement purposes, all funds received will be accounted for, and
their use reported annually in accordance with the Department of Justice and the Department
of the Treasury policies on Equitable Sharing. Falsified information on this form, failure to
expend sharing funds permissibly, or failure to accurately report expenditures could result in
the agency’s suspension or expulsion from the Equitable Sharing Program.

Name:

Title:

Signature:

Date:

B.

As legal counsel, I have reviewed this request and I certify that the contact person identified
in Part II, on behalf of the agency referenced in Part II, has the authority to accept seized/forfeited
property and is the official to whom transfer documents and/or money should be delivered. I further
certify that the agency referenced in Part II is authorized to request and receive equitable sharing.

Name:

Title:

Signature:

Date:

TD F 92-22.46 (1/2019) PREVIOUS VERSIONS OBSOLETE

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