AO 190 (Rev. 01/09) Record of the Number of Grand Jurors Concurring in an Indictment
UNITED STATES DISTRICT COURT
for the __________ District of __________ United States of America v. ) ) ) ) )
Case No.
Defendant
RECORD OF THE NUMBER OF GRAND JURORS CONCURRING IN AN INDICTMENT As the foreperson of the grand jury of this court at a session held at , I certify that (specify number) grand jurors concurred in the indictment in this case. on
Under Fed. R. Crim. P. 6(c), this record is being filed with the court clerk and will not be made public unless the court orders otherwise.
Date:
Foreperson's signature
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