BSA/AML Examiner School - Case Study Oct 2023

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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

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Part I Person Involved in Transaction(s) 1

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1

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

Multiple transactions Check

3

If entity

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

Unknown

GATEWOOD

*5 First name

Unknown

TAY

6 Middle name

Suffix

MALE

7 Gender 8 Alternate name

TEACHER

9 Occupation or type of business

9a NAICS Code

Unknown

* 10 Address

459 EAST MAIN STREET

Unknown

* 11 City

FT. LAUDERDALE

Unknown

Unknown

55555-9409

* 13 ZIP/Postal Code

* 12 State

TN

Unknown

*14 Country

US

Unknown 103-32-2623

SSN-ITIN

16 TIN type

* 15 TIN

Unknown 03/19/1990

*17 Date of birth

18 Contact phone number

555-458-9902

Ext.

GATEWOOD@HOTMAIL.COM

19 E-mail address

* 20 Form of identification used to verify identity

Unknown

Driver's license/State ID

Passport

Alien Registration

Other

21023705

Number

TN

Issuing State

US

Country

74,100

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

$

+ -

Account number

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

$

+ -

2651134

500

Account number

2651135

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