BSA/AML Examiner School - Case Study Oct 2023

This form has been signed and cannot be altered.

Currency Transaction Report

Step 3. Person(s) Involved Information

Step 4. Amount and Type of Transaction(s)

Step 2. Transaction Location(s) Information

Step 1. Filing Institution Contact Information

Home

Part I Person Involved in Transaction(s) 2

of

+ -

2

Person conducting transaction on own behalf

Person on whose behalf transaction was conducted

Person conducting transaction for another

*2

Common carrier

a

b

c

d

3

Multiple transactions

Check *4 Individual's last name or entity's legal name

If entity

Unknown

LAY

*5 First name

Unknown

LINDA

6 Middle name

Suffix

7 Gender 8 Alternate name

Female

GOLF COURSE MANAGER

9 Occupation or type of business

9a NAICS Code

Unknown 1789 GREEN GATE WAY 1789 GR EN GATE

* 10 Address

Unknown FT. LAUDERDALE

* 11 City

Unknown

Unknown 55555

* 13 ZIP/Postal Code

* 12 State

TN

Unknown

US

*14 Country

Unknown 810-36-6541

SSN-ITIN

16 TIN type

* 15 TIN

Unknown 09/18/1995

*17 Date of birth

555-669-5964

18 Contact phone number

Ext.

LLINDAY@GOLF.COM

19 E-mail address

* 20 Form of identification used to verify identity

Unknown

Driver's license/State ID

Passport

Alien Registration

Other

102497787

Number

TN

Issuing State

US

Country

10,600

21 Cash in amount for individual or entity listed in Item 4

$

+ -

575010815 63325

Account number

63325

22 Cash out amount for individual or entity listed in Item 4

$

+ -

Account number

This form has been signed and cannot be altered.

Page 5 of 6