AO 95(Rev. 10/17)ADMINISTRATIVE OFFICE OF THE UNITED STATES COURTSINFORMATION ON APPLICATION FOR DELAYED NOTICEPlease submit the information on this form each time judicial action is taken on an application for a delayed-noticesearch warrant or for an extension of a delayed-notice period. See 18 U.S.C. 247 3103a(d)(1). If extensions to the noticeperiod are requested, information will need to be submitted more than once.Information should be submitted through CM/ECF. For more information, see the Delayed Notice Search Warrant pageon the J-Net.Name of Judge:(check if state court judge)Federal Judicial District:1.Date of Application for Delayed Notice:2. Offense (Most Serious) Specified:Although the warrant may state a specific offense, please consider the broader category in which the offense falls when selecting an offense.DrugsExtortion/RacketeeringFraudFugitive/EscapeImmigrationKidnappingSex OffensesTaxTerrorismTheftWeaponsOther (if possible, specify from the below):ArsonAssaultBriberyCivil RightsComputerConspiracyContrabandCounterfeitCurrencyEnvironmentEspionageFirearmsGamblingIEEPAMoney LaunderingMurderObstructionRobberySmugglingWildlife3.Type of Application:Initial request for delayExtension of previously authorized delay (Number of extensions previously granted:)4.Judicial ActionDeniedGrantedGranted as modified5.Case Number (e.g., 221mc222 Number) of Warrant::--office yeartypenumber6.Period of Delay Authorized in This Action (days):7.Preparer222s Name:Title:Phone number:Date of report:Please submit the information on this form electronically through CM/ECF. American LegalNet, Inc. www.FormsWorkFlow.com