AO 108 (Rev_ 06/09) Application for a Warranl to Seize Property Subject 10 Forfe1ture

UNITED STATES DISTRICT COURT

for the

_,

__-c,.

District of South Carolina

o----"

Tn the Matter of the Seizure of

(Briefly describe the property to be Sel=ed)

All funds on deposit in Cause No. 141-277896-15 of

the 141st Judicial District Court of Tarrant County,
Texas, Buckland v. Athene et al.

)
)
)
)

~J>

~u:
(")~

Case No.

....;.-

o'

-u
N

APPLICATION FOR A WARRANT

TO SEIZE PROPERTY SUBJECT TO FORFEITURE

rn

:;!.)

I, a federal Jaw enforcement officer or attorney for the govemment, request a seizure warrant and state under
Northern
District of
penalty of perjury that Thave reason to believe that the following property in the
Texas'-____ is subject to forfeiture to the United States of America under _1_B_U.S.C
981
(describe the property):
a :I funds on deposit in Cause Number 141-277896-15 of the 141 st Judicial District Court of Tarrant County, Texas
which represent the proceeds of the specified life insurance policies identified in the supporting affidavit

The application is based on these facts:

See attached affidavit.

ii1f Continued on the attached sheet.

Appl1canr 's signature

FBI SA Ronald Grosse

Printed name and title

Sworn to before me and signed in my presence.

Date:

/Jovwtxrc91, d-Ol(o

Jud

ge J. Gossett
City and state: Columbia, South Carolina

U.S. MAGISmATE JUDGE;

Printed name and tirle

-4

;;::J
;;::J

y-rj

~p
n1'1
oC
c:=

-- ::::.. -'""::::>r
:o<:o
w
-<

,.....:-::

....,
=
""
0
,..,

---\

MFJD&!I.JN SUPPORT OFSEIZURE WARRANT

1.

I, Ronald Grosse. am Special Agent (SA) with the Federal Bureau of Investigation (FBI). and have been so employed

since A~rH 1990. I am, and have always been. assigned to a White Collar Crime (WCCf Squad in the Columbia
Division of the FBI. I have conducted numerous investigations of various types of WCC, including but not limited to
insurance fraud. The information contained in this a<fidavit is based on my personal knowl<:!dge and observation or as

otherwise reported. Additionally, the facts related in this affidavit do not reflect a:t the information known to me or
other law enforcement personnel, but instead, are intended to supply information sufficient to show probable cause
for a seizure wam:mt for the <.~foremen!IOned funds.

Th1s Affidavit is be1ng subm1tted to support the seizure of the assets described below for which there is probable
cause to believe constitute, or are derived from, proceeds of illegal activ1ty and/or constllute, or are derived from,
proceeds that are traceable to proceeds of Wegal act1vity 1n violation of Title 18, U.S. Code, Sections 1341 and 1343
(mail and wire fraud):

All funds, monies and other things of value interpled and/or deposited in the registry of the 141"' Judicial 01strict Court

of Tarrant County. Texas under consolidated Cause Number 141-277896-15, Buckland v. Athe'"le An'""tuity aillL..Lite
~any

f/k/a Ayjva Li.fe and Annpjty CQ'DQai"ly et al, including interest earned since deposit, said funds consisting of

the below life msurance policies totaling $5,000,000:

A.

Athene Annuity & life Assurance Company, formerly known as Aviva L1fe and Indianapolis Life. policy number

IL02599900 $500,000

B.

Athene Annuity & Life Assurance Company, formerly known as Aviva Life and Indianapolis Life. policy number

ll02600180- $1 ,000,000

3.

C.

Ohio National Life Assurance CorporatiOn policy number 6847485-$1,000,000

D.

John Hancock life Insurance policy number 93053267-$2.000,000

E.

John Hancock Life lnsurance policy numter 93053263- SSOO,OOO

The above-referenced life insurance po icies have been interpled pursuant to state court proceedings in the State of
1

Texas in the case of Mari<:_Bu~.A...t'le~i1Y..iillQ._L11e Corrpao.y_jlk/a Aviva Life ..aruiAD.r_l.l.iJ~fi~,J

f.QL)IJ Individually a.oQ_as Personal RemesentaQve of the Estate of Ani~a Fox Deceased v. Virajnia Buckland, Oistr1ct

Court of Tarrant County, Texas, Cause No.141-277-896-15.

I have learned that the interested parties will be

participating in a mediation on December 1, 2016 in Fort Worth, Texas. I have further learned that it is anticipated
that all insurance proceeds will be deposited with the state court on or about December 1, 2016.

Followmg the

interpleding of these life insurance proceeds. the state court will release the funds to some or all of the beneficiaries
as eel ermined at the December 1, 2016 mediation and/or shortly thereafter. Therefore, t respectfully request that this
Court 1ssue an antiCipatory se1zure warrant that permits federal law enforcement agents to selze the funds that have

been interpled in consolidated case number 141-277-896-15 immed1ately Jpon the Texas state court's relinquishment
of junsdrction over these funds to the bencficianes {Mark Buckland, Virgm1a Buckland, and/or AI Fox 111. lndivrdua!ly
and as Personal Representative of the Estate of Anita Fox. Deceased).

4.

Based on the mform<:ltion contained 1n thrs Affidavit, there rs probable cause to believe that Charles Mercrer assrsted
1n pron.1ring these life insurance policies in vtolation of 18 U.S.C. 1341 and 1343

5.

Title 18, United States Code, Section 981(a)(1){C}. provides that the following properties are subject to civil forfeiture
to the government of the United States

w(d) Any property, real or personnl, which constitutes or is dcnved frorn proceeds traceable to

.. any offense

constituting "specified unlawful activity".

6.

Title 28, Untied States Code, Section 2461, provides for the criminal forfeiture of property that is subject to civ1!
forfei!ure.

7.

Title 18, United States Code, Section 981{b}(1) provides that "any property subject to forfeiture to the United States
under subsection {a) may be seized by the Attorney General.

8.

Titie 18, United States Code, Section 981(b){3) provides that "a seizure warrant may be issued pursuant to this
subsection by a judicial off1cer in any district in which a forfeiture action against the property may be filed ... and
may be executed in any d:strict in which the property is found."

Tit:e 21, United States Code, Sections 853{f) provides that "the Government may request the issuance of a warrant
authorizing the Seizure of property subject to forfeiture under th1s section in the same manner provided for a search
warrant_"

E'RQ.6ABLE CAUSE

10.

By way of background, an insurance fraud investigation was init1ated tn July 2014, the subjects of which belong to a
community in North Augusta, South Carolina commonly referred to as "Irish Travelers". This group travels throughout
the South and Southwest United States generating income through various construction related jobs. While there are
pockets of Travelers around the country and other ethnic "gypsy" groups, the largest concentration o1 Irish Travelers
is in North Augusta. The FBI investrgation at first centered on the fraudulent application for life rnsurance by members
of the Traveler community but later included other violations of federal statutes. Travelers have been known to be
involved in life insurance scams in the past. These scams typically involve lying on the policy applications about
mcorne, net worth, health, identifymg information, and whether other polic1es have been issued.

11.

During the course of FBI Coh.:mbia's invest:gation, it was discovered that Charles Mercier, an insurance agent in
North Augusta whose family writes l1fe insurance policies almost exclusively for Travelers, had written five policies
totaling $5 m:!lion in 2007 and 2008 on Anita Fox, an English Traveler who lived in Hurst. Texas. The life insurance

policies are identified are set forth in paragraph 2 above. In the summer of 2013, the ownership and beneficiary of a

$1 million policy on Fox with Aviva Life was changed. Fox's daughter, Virginia Buckland, was the beneficiary and her
husband, Mark Buckland, was the owner of tt'.e $1

mi~hon

policy.

12. In July 2013, documents were prepared changing the benef:ciary of this policy to Pat Gorman, an Irish Traveler who
resided in Virginia. Gorman was also added as a co-owner on the policy. In order to satisfy Aviva that Gorman had

an insurable mterest in Fox, the Change or Beneficiary Form indicated that Gorman was a partner with Fox 1n a mobile
home park.
13.

On September 23,2014, Anita Fox was murdered in a house she was cleaning in Colleyville, Texas.

14. During a law enforcement interview of Charles Mercier. he admitted that he lied on the original 2007 and 2008
insurance policy applica\ioi"\S for Fox by making up fictitious asset and liability f1gUTes in an effort to get the policies
issued

15. He also admitted to lying on insurance forms in 2013 when he indicate? that Fox and Pat Gorman were partners in a
mobile home park.

Lastly, Mercier acknowledged that in 2013. the signature of V1rginia Buckland on the lorm

changing the ownership of the $1 million A viva policy was forged.

16. The life insurance applications and most of the associated forms were sent by fax. e-mail, U.S. Mail, or other
commercial interst<Jte carrier from Mercier in South Carolin<J to the offices of A viva, Ohio National, and John Hancock,
all located outside of South Care tina.
17. Mercier went on to say that in 2013 Buckland called him and told him he couldn't afford the premiums on the Fox
policies. Mercier offered to help him. He contocted Harry Gorman. Pat Gorman's brother, for whom Merc1er and his
father had written policies in the past Mercier explained that Harry Gorman had called him before looki'1g for policies
to "invest" in. Mercier told him about the Fox pol1cies and asked him if he could pay the prem1ums on

Ol"\e

of tre

policies in exchange for one of the Gormans being named as the beneficiary. It was agreed that Joe. Harry, Pat. and
Mike Gorman. would collectively pay Mark Buckland $2,800 a month in exchange for Pat Gorman b<ling named the
beneficiary of a $1 million life msurance poi!CY on Fox. The prem1ums were paid by the Germans for about a year
before Fox was murdered in September 2014.

18. The pol1ce ln Texas have strong circumstantial evidence that Joe Gorman killed Anita Fox. Joe Gorman died of
natural causes before he was arrested for Fox's murder. Joe Gorman's son, Joe Gorman, Jr.. has been indicted in
Texas on murder charges relating to his mvolvernent in Fox's murder

19. The Indianapolis Life (Aviva) insurance application prepared by Mercier in 2007 indicated that Anita Fox was a selfemployed mob.lle home park owner W.th an income of $300,000 a year and a net worth of $2,000,000. A financial
questionnaire prepared by Mercier for Fox and subm1tted to Indianapolis Life

tn

February 2008 clams that Fox had

$900,000 in that bank, made $22,000 a month in rental income, owned $2,000,000 in real estate and total assets of
$3,050,000. Her only liability listed was a $185,000 mortgage on her residence.
20.

The Ohio National life insurance application and subsequent financial questionnaire prepared by Mercier for Fox
indicated that she made $250,000 a year salary, and had rental income of $25.000 a month.

21. The John Hancock applications submitted by Mercier for Fox ln 20C8 indicated Fox owned and operated mobile
home parks. made $250,000 a year and had a net worth of $1,800.000.

22.

In addition to Mercier adm1tting he made up some of the numbers submitted to the insurance companies. real estate
records, tax records, and interviews revealed that Fox did not own any mobile home parks in November 2007 or at
any !1me thereafter. Also. the lndianapoiis life and Ohio National polices were not revealed to John Hancock.

23.

lt is my belief based on my knowledge of the insurance industry and tile statements of representatives of !he
insurance companies involved, that had they known that the employn;ent, income, and net worth information provided
to them on applications submitted in 2007 and 2008 was false. they never would have issued the Fox policies.
Further, had Av1va (formerly Indianapolis Life) known that Pat Gorman was not a bus1ness partner of Anita Fox and
that Virgin1a Buckland's s1gnature was forged on the Change of Beneficiary and Change of Ownership forms
subm1tted by Mercier in 2013. those changes would not have been authorized

24. The suspected fraud Involved in the procurement of the specified life insurance poliCies coupled w:th the murder of
Anita Fox led to the lawsuits filed in Tarrant County, Texas. The lawsuits were then consolidated in October 20i6 to
the 1-11"' Judicial District Court of Tarrant County. Texas consolidated cause number 141~277896-15.
25.

Based on the aforementioned. I believe there is probable cause to believe that the funds listed above are proceeds
and/or traceable to proceeds of violations ofTitle 18, United States Code, Sections 1341 and 1343 and therefore are
subject to seizure and forfeiture pursuant to 18 U.S.C. 981(b): 21 U.S.C. 853 (D: and 18 U.S.C. 982(b)(1).

26

Accordingly, I respectful\y request that this Court issue an anticipatory seizure warrant which would permit federal law
enforcement agents to se1ze. for purposes of civil and/or criminal forfeiture, the funds ir1terpled to the Texas state
court in Tarrant County, Texas case number 141-277896-15 immediately upon the Texas state courl's relinquishment
of jurisdiction over these funds to the beneficiaries.

27.

Based on my traming and experience, I know that restraining orders served on individuals, especially those
suspected of fraud, fait to preserve the property for forfeiture because the individuals will dissipate and/or hide the
proceeds after receiving them. tn this case. the life insurance beneficiaries are suspected of engaging 1n fraud
and/or the murder of the insured Anita Fox. Therefore. a restraining order d1recting such beneficiaries to preserve the
insurance proceeds would be insufficient tn ensure the availability of the funds for forfeiture_ h co11trast, a seizure
warrant guarantees that the funds will be in the Government's custody and preserved once the warrant is served.

28. This affidavit has been reviewed by Assistant United States Attorneys Carrie Fisher Sherard and Jim May

~-~"
lk\
i\

Rona!d Grosse, Special Agent, FBI

Subscribed and sworn to before me