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

RAY

*5 First name

Unknown

RAYMOND

6 Middle name

Suffix

Male

7 Gender 8 Alternate name

MANAGER

9 Occupation or type of business

9a NAICS Code

Unknown

* 10 Address

2425 GRAND AVENUE

Unknown

* 11 City

FT. LAUDERDALE

Unknown

Unknown

55555

* 13 ZIP/Postal Code

* 12 State

TN

Unknown

*14 Country

US

Unknown

SSN-ITIN

16 TIN type

908-88-1414

* 15 TIN

Unknown 08/14/1964

*17 Date of birth

555-157-9898

18 Contact phone number

Ext.

19 E-mail address

* 20 Form of identification used to verify identity

Unknown

Driver's license/State ID

Passport

Alien Registration

Other

CONSULAR ID CARD

20588360

Number

Issuing State

MX

Country

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

$

+ -

Account number

69,300

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

$

+ -

7184180 6932

Account number

This form has been signed and cannot be altered.

Page 5 of 6