T-MOBILE / METRO PCS Exigent Form Please fax to (813) 801 ...

1 REV Exigent Request form Please fax to (813) 801-8863 or email to Name of Government Entity: Government Entity address : City, State, Zip: Government Entity Phone Number: Fax Number: Requesting Officer/Agent Name, Title, Badge, or ID Number: Agent Call Back Number: Agent email : Supervisor s Name: Supervisor s Phone Number: I hereby certify that I am employed by the above-named government entity and have been granted authority by the entity to determine and declare an Exigent circumstance involving: a)Immediate danger of death or serious physical injury to any )Conspiratorial activities threatening the national security interest (Only for PEN registers or Wiretaps).c)Conspiratorial activities characteristic of organized crime (Only for PEN registers or Wiretaps).d)Ongoing attack on a protected computer (Only for PEN register).The following facts establish the Exigent /emergency: Target Phone Number(s) Involved: Current Location (One-Time Ping) Call Detail Records (Last 48 Hours) Call Detail Records with Cell Sites (Last 48 Hours) Continuous Location (15 Minute Intervals for 48 Hours) Pen Register or Wire Tap HANDWRITTEN SIGNATURE PRINTED NAME DATE T- mobile US, INC.

2 Law Enforcement Relations - (973) 292-8911 (813) 801-8863 (FAX) All responsive information will be returned to a government email address , No to povide a clearly written or typed response to any field will delay TelephoneOtherThe urgency of the sitation makes it unfeasible to obtain a written legal demand for the information sought. Accordingly, I am requesting release of the following customer must have access to CALEA delivery equipment currently established with T-MOBILE to receive CALEA based services. If it is later determined that one or more of the above conditions does not exist and/or my request is not authorized by governing legal authority, I understand that I may be held liable for civil and/or criminal penalties either as an individual, as an organization, or both. By signing this form , I certify the information herein is true and correct. Pursuant to 18 USC. 2518, 2702, 3125 and any other applicable Federal or State statute, all lawful interception and location information assistance will terminate if the appropriate legal demand or customer consent is not received within 48 hours.

3 The valid legal demand or customer consent should reference the existence of this Exigent circumstance request. Use beyond 48 hours may also incur fees. This request is made pursuant to 47 222(g), 18 2702 and 47 and subject to state and federal perjury penalties.