WT-2 (Rev. 08/09) ADMINISTRATIVE OFFICE OF THE UNITED STATES COURTS PART 1 (JUDGE’S REPORT) REPORT OF APPLICATION AND/OR ORDER AUTHORIZING INTERCEPTION OF COMMUNICATIONS (To be completed upon approval or denial of application pursuant to 18 U.S.C. 2519(1)) 1. JUDGE AUTHORIZING OR DENYING THE APPLICATION Judge’s Name: County/Court/District/Jurisdiction: Court Reference No.: 2. SOURCE – OFFICIAL MAKING APPLICATION Official’s Name: Title: (i.e., AUSA, DA, ect..) Telephone No.: Jurisdiction/Agency: 3. PROSECUTION OFFICIAL AUTHORIZING APPLICATION Prosecutor or DAAG Name: District/Jurisdiction: Telephone No.: Prosecutor Reference No.: 3A. LAW ENFORCEMENT AGENCY CONDUCTING THE WIRETAP Agency’s Name: (FBI, DEA, Sheriff, etc..) Contact Person: Telephone No.: 4. OFFENSE (MOST SERIOUS) Agency Reference No.: 5. TYPE OF ORDER (Check Ordinary or Roving Order) ’ Ordinary (Routine) Specification Order ’ Roving – Relaxed Specification Order under 18 U.S.C. 2518 (11) Description (e. g., Narcotics, Gambling) (ALSO CHECK “NO LOCATION SPECIFIED” IN ITEM 8, BELOW) 6. DURATION OF INTERCEPT Order or Extension ORIGINAL REQUEST 1st Extension 2nd Extension 3rd Extension List additional extensions on separate sheet No. of Days Date of Application Check One Denied Granted TOTAL NUMBER OF EXTENSIONS: Date Order Denied or Granted Was this Order/Extension Granted with Modification or Amendment? (Check only if “Yes”) ” Modified/amended – DATE: ” Modified/amended – DATE: ” Modified/amended – DATE: ” Modified/amended – DATE: TOTAL DAYS AUTHORIZED: 7. TYPE OF INTERCEPT (Check all that apply to this order/authorization) ” ORAL – check device(s) ” ELECTRONIC – check device(s) COMMUNICATIONS – check device(s) ” Microphone / Eavesdrop ” Computer (including ” Other electronic E-mail) device (specify) ” Cellular or mobile telephone ” Other type (specify) ” Standard Telephone (land line) ” Digital pager ” Other type of telephone communication ” Fax machine device (specify) ” Text messaging 8. LOCATION SHOWN IN INTERCEPT ORDER (Check all that apply to this order/authorization) ” PERSONAL RESIDENCE (specify) ” PORTABLE DEVICE - CARRIED BY/ON INDIVIDUAL (specify) ” WIRE INTERCEPT OF PHONE (e.g., single family house, apartment, mobile home, rooming house, dormitory) ” BUSINESS (specify) (e.g., store, office, restaurant, gym, hospital, school) ” PUBLIC AREA (specify) (e.g., pay telephone, park, station, airport, library, street, cemetery) (e.g., cell phone, pager) ” OTHER LOCATION (specify) (e.g., motel, prison, jail, vehicle, another specified location not listed) ” NO LOCATION SPECIFIED IN ORDER (specify) (either “roving” as shown in item 5, or other circumstances. Describe.) Judge’s signature: Telephone No.: Date: INSTRUCTIONS When Part 1 (Judge’s Report) is completed, do the following: (1) Send a copy to one of the following: Mail - (2) (3) Administrative Office of the U.S. Courts, Attn: Statistics Division (WT), One Columbus Circle, NE, Washington, DC 20544 Fax 202-502-1422 E-mail - SD-Wiretap@AO.USCOURTS.GOV Provide the Form WT-2 to the official making the application Retain a copy for the judge’s files Report Prepared By: Telephone No.. (Area Code) American LegalNet, Inc. www.FormsWorkFlow.com WT-2 (Rev. 08/09) ADMINISTRATIVE OFFICE OF THE UNITED STATES COURTS PART 2 (PROSECUTOR’S REPORT) REPORT OF APPLICATION AND/OR ORDER AUTHORIZING INTERCEPTION OF COMMUNICATIONS (To be completed upon termination of investigation pursuant to 18 U.S.C. 2519(2)) JUDGE AUTHORIZING OR DENYING THE APPLICATION Judge’s Name: LAW ENFORCEMENT AGENCY Agency Reference No.: County/Court/District/Jurisdiction: PROSECUTION OFFICIAL AUTHORIZING APPLICATION Prosecutor Reference No.: Telephone No.: Prosecutor or DAAG Name: NOTE: Items listed above should match information entered on Part 1 of Form WT-2. 9. INSTALLATION INSTALLED BUT NOT USED (Skip to Item 11) ” ” NEVER INSTALLED (Skip Items 10 through 12) 10. DESCRIPTION OF INTERCEPTS 10A. Termination Date of Interception 10B. No. of Days in Actual Use ” INSTALLED AND USED (Complete Form) 10C. No. of Communications 10D. No. of Persons Whose Intercepted Communications were Intercepted 10F. Was Encryption Encountered in this Wiretap? ’ Yes ’ No 10E. No. of Incriminating Communications Intercepted 10G. If Yes, Did Encryption prevent Law Enforcement from Obtaining the Plain Text of Communications Interception? ’ Yes ’ No 11. COST Check if Applicable: ” Costs for this wiretap are not reported here, but are shown on Reference Number(s): ___________________________________________ 11A. Nature and Quantity of Personnel Used to 11B. Personnel Cost (Round to Nearest Dollar): Install, Monitor, and Prepare Transcripts : $ + 11C Resource Cost installation fees, supplies, equipment, etc. (Round to Nearest Dollar): = $ 11D. Total Cost = Personnel + Resource (Round to Nearest Dollar): $ 12. RESULTS ” Check here if case is pending and there are no results to report (results not reported here should be reported on the WT-3 Supplementary Report) Check if Applicable: ” Arrests for this wiretap are not reported here, but are shown on Reference Number: __________ 12A. No. of Persons Arrested 12B. No. of Motions to Suppress Granted Denied Pending 12C. No. of Persons Convicted 12D. No. of Trials Completed 12E. Conviction Offense 13. COMMENTS AND ASSESSMENT Describe importance of the interceptions, drugs and money seizure amounts, impact on crime or community etc. DO NOT include target’s names, addresses, phone numbers, name of gangs, or other sensitive information. Signature of Authorizing Prosecutor: Telephone No.: Date: INSTRUCTIONS When Part 2 (Prosecutor’s Report) is completed, (1) Make copies for your files (2) States Only - send completed originals of Part 1 and Part 2 to one of the following: Mail Administrative Office of the U.S. Courts, Attn: Statistics Division (WT), One Columbus Circle, NE, Washington, DC 20544 Fax 202-502-1422 E-mail - SD-Wiretap@AO.USCOURTS.GOV (2A) Federal Only - submit completed copy of Part 1 and Part 2 to: Federal Law Enforcement Agency Contact Official (3) Federal Law Enforcement Agency Contact Official - send completed Part 1 and Part 2 to Office of Enforcement Operations, DOJ, Washington D.C. Report Prepared By: Telephone No. (Area Code): American LegalNet, Inc. www.FormsWorkFlow.com