TD F 92-22.46 (10/2021) PREVIOUS VERSIONS OBSOLETE 1

DEPARTMENT OF THE TREASURY OMB No. 1505-0152

Request for Transfer of Property Seized/Forfeited by a Treasury Forfeiture Fund Participating Agency

 All assets transferred must be used in accordance with the U.S. Department of Justice and U.S Department of the

Treasury Guide to Equitable Sharing for State, Local, and Tribal Law Enforcement Agencies.

 The deadline for submission of this request is forty-five (45) days following the forfeiture date of the asset

requested.

 The requesting agency will be responsible for reimbursing the Treasury Forfeiture Fund its costs.

I. Seizing Agency (For Treasury Fund Participating Agency Use Only)

Case Type: Adoption Joint 

II. Requesting State or Local Agency 

 Requesting Agency:

NCIC/ORI Number:

Email Address:

 Requesting Agency Case No.:

Seizing Agency (Federal):

Seizure Number Forfeiture:

Date:

Field Office:

Federal Agency Case No. 

Address: 

 City:

Recipient Agency Fiduciary for:

State:

 Zip Code:

Contact Person:

Telephone Number:
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 Seizure Number: ____________________ 

III. Asset Requested (If requesting more than one asset, please attach a list)

Asset Requested : _________________________ 

Asset Description: _________________________ 

Request Type: Item: _________________

IV. Recipient Agency Participation/Contribution

Yes No

How many workhours were expended in the seizure/forfeiture of this asset?

Will sharing be based on pre-determined percentage in a Task Force Agreement

that was applicable at the time of the seizure/forfeiture?

If YES, please attach the Memorandum of Understanding/ Agreement.

Summary of Participation to the seizure and forfeiture of the referenced asset:

*****Summary should include information such as who initiated the investigation, did the 

requesting agency provide POI/POE payments and the amount, were extraordinary 

expenses incurred by the requesting agency (i.e., Pens/Ping orders, T-III, etc., and any 

specific assistance (i.e., narcotics K-9, computer forensic assistance, SRT, etc.) that lead to 

the seizure of the referenced asset*****

Cash Proceeds: _______

_________________
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 Seizure Number: ___________________ 

A. I certify that the above information including, but not limited to, the number of workhours and the 

narrative contributions to the investigation, are true and accurate statements of this agency’s 

activities. I further certify that the funds or property transferred will be used only for permissible law 

enforcement purposes, all funds received will be accounted for, and their use reported annually in 

accordance with the Department of Justice and the Department of the Treasury policies on Equitable 

Sharing. Falsified information on this form, failure to expend sharing funds permissibly, or failure to 

accurately report expenditures could result in the agency’s suspension or expulsion from the 

Equitable Sharing Program.

B. As legal counsel, I have reviewed this request and I certify that the contact person identified 

in Part II, on behalf of the agency referenced in Part II, has the authority to accept seized/forfeited property 

and is the official to whom transfer documents and/or money should be delivered. I further certify that the 

agency referenced in Part II is authorized to request and receive equitable sharing. 

Title:______________________________________

Date: _____________________________________

Title:______________________________________

Date: _____________________________________ 

Name: ______________________________________

Signature: _____________________________________

V. Department of the Treasury Title VI Civil Rights Requirements

Language Assistance Plan – The recipients must develop a language plan to offer assistance to limited English

proficient beneficiaries as needed. – Existing Recipient Guidance Regarding Executive Order 13166,70 Fed. Reg.

6067 (February 4, 2005).

Does the Recipient Agency have a Language Assistance Plan? Yes No

Location of Notice of Rights – Recipients are required to provide information to beneficiaries and participants of the

protection against discrimination.

Does the Recipient Agency have a Notice of Rights? Yes No

Where is the Notice Posted? _________________________________

VI. Certification by Participating/Fiduciary Agency

Is the agency authorized to submit a request for an equitable sharing of this asset under applicable State law?

Name: ______________________________________

Signature: _____________________________________

Yes No