BSA-AML Examiner School Case Study eBook

This form has been signed and cannot be altered.

Currency Transaction Report

Step 3. Person(s) Involved Information

Step 2. Transaction Location(s) Information

Step 4. Amount and Type of Transaction(s)

Step 1. Filing Institution Contact Information

Home

+

-

Part III Transaction Location 1

of 1

Would you like to insert all applicable filing institution information into Part III?

Yes

Depository institution

*38 Type of financial institution

Other (specify)

* 29 Primary federal regulator

Federal Reserve

39 If 38a - Casino/Card Club is checked, indicate type (check only one) State licensed casino Tribal authorized casino

Card club

Other

* 30 Legal name of financial institution

TS&J BANK

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

Unknown

* 32 EIN

470006789

* 33 Address

555 MAIN STREET

OMAHA

* 34 City

* 35 State

NE

68509

*36 ZIP Code

US

*37 Country

Research, Statistics, Supervision and Discount (RSSD) number

40 Financial institution ID type

5999

ID number

15,000

*41 Cash in amount for transaction location

*42 Cash out amount for transaction location

Page 3 of 5

This form has been signed and cannot be altered.