WT-2B State (Rev. 10/2015) Administrative Office of the United States Courts Part 1 (Judge's Report - State / County / Local) Report of Application and/or Order Authorizing Interception of Communications (To be reported by January 31 for denied applications and for approved applications for orders that expired during the preceding year, pursuant to 18 U.S.C. § 2519(1)) 1. Judge Authorizing or Denying the Application Judge's First Name: State: Select: Court Jurisdiction: Middle Initial: Last Name: Other Court Jurisdiction: Suffix: Court Reference No.: 2. Source - Official Making Application Official's First Name: Title: (i.e., DA, etc.) Select or enter a title: Prosecutor's First Name: Prosecutor's Jurisdiction: Prosecutor Reference No.: Middle Initial: Middle Initial: Last Name: Official's Jurisdiction/Agency: Suffix: Telephone No.: 3A. Prosecution Official Authorizing Application Last Name: Other Prosecutor's Jurisdiction: Suffix: Telephone No.: 3B. Law Enforcement Agency Conducting the Wiretap Agency Name (FBI, DEA, Sheriff, etc.) Contact Person's First Name: Middle Initial: Last Name: Agency Reference No.: Suffix: Telephone No.: Extension: 4. Offense (Most Serious) Most Serious Offense: Select: Title/Section of Offense: 5. Type of Order (Select One) Ordinary Specification Order (including most cell phone wiretaps) Roving - Relaxed Specification Order Granted under 18 U.S.C. 2518(11) 6. Duration of Intercept Order or Extension Original Request 1st Extension 2nd Extension 3rd Extension 4th Extension 5th Extension 6th Extension Use the last page of the form for additional extensions. Total Number of Extensions: 0 No. of Days Date of Application Check One Denied Granted Date Order Denied or Granted Date that a Granted Order/Extension was Modified or Amended, if applicable. Date Modified /Amended Date Modified /Amended Date Modified /Amended Date Modified /Amended Date Modified /Amended Date Modified /Amended Date Modified /Amended Total Days Authorized: 0 Page 1 WT-2B State (Rev. 10/2015) 7. Type of Intercept (Check all that apply to this order/authorization) Phone - check device(s) Cellular or Mobile Telephone Standard Telephone (land line) Other (specify) Oral - check device(s) Microphone / Eavesdrop Other (specify) Electronic - check device(s) Computer (including email) Digital Pager Fax Machine Text Messaging App Other (specify) 8. Location Shown in Intercept Order (Check all that apply to this order/authorization) Portable Device - Carried by/on Individual (e.g., cell phone, pager) Personal Residence (e.g., single family house, apartment, mobile home, rooming house, dormitory) Business (e.g., store, office, restaurant, gym, hospital, school) Public Area (e.g., pay telephone, park, station, airport, library, street, cemetery) Other Location (e.g., motel, prison, jail, vehicle, another specified location not listed) Specify No Location Specified in Order (either "roving" as shown in item 5, or other circumstances) Describe 8A. Judge's Signature (Use /s/ or Check Endorsement Box) Date: Judge's Endorsement Telephone No.: 8B. Report Prepared By Report Preparer's First Name: Title: Middle Initial: Last Name: Suffix: Telephone No.: Date: Extension: Instructions When Part 1 (Judge's Report) is completed, do the following: (1) Click the "Validate Part 1" button to identify any data quality issues with Part 1. (2) Save a PDF copy of the completed form by clicking the "Save As" button below and assigning a unique file name. (3) Click the "Submit by Email" button below to submit this form or attach one or more saved PDF forms to an email and send to SD-WIRETAP@AO.USCOURTS.GOV. (4) Provide an electronic copy of the completed Part 1 to the official making the application. (5) Retain a copy of the completed Part 1 for the judge's files. Additional Instruction Judges stop here. Prosecutors and Law Enforcement Agencies continue to Part 2 of the WT-2 Form. Page 2 WT-2B State (Rev. 10/2015) Administrative Office of the United States Courts Part 2 (Prosecutor's Report - State / County / Local) Report of Application and/or Order Authorizing Interception of Communications (To be reported by March 31 for terminated investigations, pursuant to 18 U.S.C. § 2519(2)) Judge Authorizing or Denying the Application Judge's First Name: State: Court Jurisdiction: Middle Initial: Last Name: Court Reference No.: Suffix: Prosecution Official Authorizing Application Prosecutor's First Name: Prosecutor Reference No.: Middle Initial: Last Name: Suffix: Telephone No.: Agency Reference No.: Application Date (Original Request): NOTE: Items listed above should match information entered in Part 1 of Form WT-2. 9. Installation Never Installed Installed but Not Used Installed and Used 10. Description of Intercepts 10A. Termination Date of Interception 10B. No. of Days in Actual Use 10C. No. of Communications Intercepted Unknown 10F. Was Encryption Encountered in this Wiretap? Check the option that applies: Costs for this wiretap are reported below. Costs for this wiretap are included on another wiretap form with the following reference number. Reference Number Type: Costs for this wiretap are unknown at this time. 11A. Nature and Quantity of Personnel Used to Install, Monitor, and Prepare Transcripts 11B. Personnel Cost 11C. Resource Cost (installation fees, supplies, equipment, etc.) 11D. Total Cost = Personnel Cost + Resource Cost Reference Number: Yes No 10D. No. of Persons Whose Comm. Were Intercepted Unknown Yes 10E. No. of Incriminating Comm. Intercepted Unknown No 10G. If Yes, Did Encryption Prevent Law Enforcement from Obtaining the Plain Text of Communications Intercepted? 11. Cost (Rounded to Nearest Dollar) + $ Check the option that applies: = $ $ 12. Results Results for this wiretap are reported below. Results for this wiretap are included on another wiretap form with the following reference number. Reference Number Type: Reference Number: Results for this wiretap are not known at this time. (Future results should be reported on the WT-3 Supplementary Report) 12A1. No. of Persons Arrested 12A2. Arrest Offense (Most Serious): 12B. No. of Motions to Suppress Granted Denied Pending 12F. Title/Section of Conviction Offense: 12C. No. of Persons Convicted 12D. No. of Trials Completed 12E. Conviction Offense (Most Serious): Page 3 WT-2B State (Rev. 10/2015) 13. Comments and Assessment Describe importance of the interceptions, drugs and money seizure amounts, impact on community, etc. DO NOT include target's nam