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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 for the law enforcement purpose stated in this request.
The deadline for submission of this request is sixty (60) days following the seizure of the
asset requested.
The requesting agency will be responsible for reimbursing the Treasury Forfeiture Fund
(TFF) 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 ________
Seizure Date: _________________
_____________________________________________________________________________
II. Requesting Agency
Agency Name: _______________________________ NCIC Code: __________________
Address: __________________________________________________________________
Contact Person: ____________________________________________________________
Telephone Number: ______________________
Email: _______________________
Finance/Budget Contact (regarding share deposit): ______________________________
Telephone Number: _______________________
Email: _______________________
______________________________________________________________________________
III. Asset Requested (If requesting more than one asset, please attach list)
Description: _______________________________________________________________
Percentage Requested: ________
Is this a non-monetary asset that will be placed into official use?
Yes No
______________________________________________________________________________
IV. Specific Intended Law Enforcement Use (for requested funds):
__ Salaries
__ Purchase of Vehicles
__ Purchase of Equipment
__ Other (Explain) _________________________________________________________
______________________________________________________________________________
V. Contribution (For all “yes” answers, provide details in part VI)
A. Did your agency originate the information leading to the seizure?
Yes
No
B. Were any other assets seized under state law?
Yes
No
C. Were extraordinary expenses incurred?
Yes
No
D. Did your agency supply any unique or indispensable assistance?
Yes
No
E. Are there any assets located in foreign countries?
Yes
No
F. How many hours were expended? __________
______________________________________________________________________________
TD F 92-22.46 (9/11) PREVIOUS VERSIONS OBSOLETE
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