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) 1

of

+ -

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

STRONG

*5 First name

Unknown

NEIL

6 Middle name

Suffix

Male

7 Gender 8 Alternate name

Attorney

9 Occupation or type of business

9a NAICS Code

Unknown

* 10 Address

6385 Madison Ct.

Unknown

* 11 City

Ft. Lauderdale

Unknown

Unknown

55555

* 13 ZIP/Postal Code

* 12 State

TN

Unknown

*14 Country

US

Unknown 103-68-6585

SSN-ITIN

16 TIN type

* 15 TIN

Unknown 01/07/1983

*17 Date of birth

18 Contact phone number

555-658-5103

Ext.

MRSTRONG@GMAIL.COM

19 E-mail address

* 20 Form of identification used to verify identity

Unknown

Driver's license/State ID

Passport

Alien Registration

Other

1079836585

Number

TN

Issuing State

US

Country

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

$

+ -

Account number

62,000

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

$

+ -

34485

30386

Account number

This form has been signed and cannot be altered.

Page 4 of 5

Made with FlippingBook flipbook maker