BSA-AML Examiner School Case Study eBook

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Currency Transaction Report

Step 1. Filing Institution Contact Step 2. Transaction Location(s) Step 3. Person(s) Involved Step 4. Amount and Type of Information Information Information Transaction(s)

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Part IV Filing Institution Contact Information

Depository institution

*52 Type of financial institution

Other (specify)

Federal Reserve

*43 Primary federal regulator

53 If 52a - Casino/Card Club is checked, indicate type (check only one)

State licensed casino

Tribal authorized casino

Card club

Other

TS&J BANK

*44 Legal name of filing institution

45 Alternate name, e.g. trade name, DBA

* 46 EIN

47-0006789

* 47 Address

800 MULBERRY LANE

* 48 City

EAGLE

* 49 State

NE

68888

*50 ZIP Code

US

*51 Country

Research, Statistics, Supervision and Discount (RSSD) number

54 Filing institution ID type

500500

ID number

* 55 Contact office

BSA COMPLIANCE

3086324158 555-999-9 98

Ext.

* 56 Phone number

07/24/2023

*57 Date filed

(Date filed will be auto-populated when the form is signed.)

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This form has been signed and cannot be altered.