10th Cir. Crim. Pattern Jury Instr. 2.46.1

The defendant is charged in count ————— with a violation

of 18 U.S.C. section 1001(a)(2).

This law makes it a crime to knowingly and willfully make a

[false] [fictitious] [fraudulent] statement or representation

concerning a material fact within the jurisdiction of the [executive]

[legislative] [judicial] branch of the United States.

T o fi n d t h e d e f e n d a n t g u i l t y o f t h i s c r i m e y o u m u s t b e

convinced that the government has proved each of the following

beyond a reasonable doubt:

First: the defendant made a [false] [fictitious] [fraudulent]

statement or representation to the government; specifically [as

described in indictment];

Second: the defendant made the statement knowing it was

false;

Third: the defendant made the statement willfully, that is

deliberately, voluntarily and intentionally;

Fourth: the statement was made in a matter within the

jurisdiction of the [executive] [legislative] [judicial] branch of the

United States; and

Fifth: the statement was material to [name government

entity].

A fact is “material” if it has a natural tendency to influence or

is capable of influencing a decision of [name of government entity].

It is not necessary that [government entity] was in fact

influenced in any way.