Department of Justice
Gift Acceptance Form
(Up to $150)


Please complete this form immediately upon receipt of the gift.

Send this completed form to: Property Management Services
                                            Facilities and Administrative Services Staff
                                            Department of Justice
                                            National Place Building, Suite 1070
                                            Washington, DC 20530


The following gift was presented to the U.S. Department of Justice, or an employee of the U.S. Department of Justice:

__________________________________________________________
(Description of Gift)

If non-cash, the value of the gift is estimated at $______________________
Note: This is a good faith estimate by the component. This form cannot be used for gifts valued over $150.


The component must indicate below any matters pending or likely to arise in the future that might involve the donor:

___________________________________________________________


Please identify the DOJ employee who received the gift and under what circumstances:

Employee: ___________________ Component: ______________________

Circumstances of receipt of gift:

____________________________________________________________

Donor: ______________________________________________________

Full Address: __________________________________________________


I have determined that this gift is appropriate for use by or display within the component. This gift was not solicited.

_____________________________________________________________
(Name and Signature of Component Head or designee)             (Date)

Concurrence by component Deputy Designated Agency Ethics Official (DDAEO):

_____________________________________________________________
(Name and Signature of DDAEO)                                                 (Date)

3/18/99