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

Home

Part I Person Involved in Transaction(s) 2

of

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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

BAKER

*5 First name

Unknown

VICTOR

6 Middle name

Suffix

MALE

7 Gender 8 Alternate name

GAS STATION MANAGER

9 Occupation or type of business

9a NAICS Code

Unknown

* 10 Address

3968 EAST CONNECTOR ROAD

Unknown

* 11 City

FT. LAUDERDALE

Unknown

Unknown

55555-9409

* 13 ZIP/Postal Code

* 12 State

TN

Unknown

*14 Country

US

Unknown 311-62-1185

SSN-ITIN

16 TIN type

* 15 TIN

Unknown 06/01/1985

*17 Date of birth

18 Contact phone number

555-311-2118

Ext.

BAKERBAKER19@GMAIL.COM

19 E-mail address

* 20 Form of identification used to verify identity

Unknown

Driver's license/State ID

Passport

Alien Registration

Other

21011740

Number

TN

Issuing State

US

Country

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

$

+ -

7094126

Account number

12,000

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

$

+ -

Account number

1014001

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