Appendix I Examples of the Completion of the FinCEN …

1 5 Appendix I Examples of the Completion of the FinCEN Currency Transaction Report ( CTR ) for Transactions Involving Armored Car Services 1. Bank A Single reportable transactions conducted by an armored car service on behalf of a bank or on behalf of a bank s customer On the same business day, Bank A receives currency deposits for the accounts of two accountholders, as follows: Jack s Restaurant is a large cash business that is a customer of Bank A. Bank A has contracted with Armored Car Service One ( ACS One ) to pick up the cash from Jack s Restaurant and transport it to Bank A s account with the Federal Reserve. ACS One picks up $21,000 in cash from Jack s Restaurant and delivers it to the Federal Reserve. Bank A will complete the CTR reflecting this transaction as follows: Part I (1 of 1) will show Jack s Restaurant s corporate information, checking boxes 2c ( Person on whose behalf transaction was conducted ) and Check if entity, and inserting in item 21 the deposited amount ($21,000) and Jack Restaurant s account number.

2 Part II will show the $21,000 deposited in section 25a, checking box 24 ( Armored Car (FI Contract) ). Part III will contain Bank A s information as the financial institution where transaction took place. The completed CTR is shown on pages 6 through 9 of this guidance. Bob s Warehouse is a large cash business that is a customer of Bank A. Bob s Warehouse has contracted with Armored Car Service One ( ACS One ) to pick up the cash from the warehouse and transport it to Bank A for deposit into Bob s Warehouse account. ACS One picks up $21,000 in cash from Bob s Warehouse and delivers the cash to Bank A. Bank A will complete the CTR reflecting this transaction as follows: Part I (1 of 2) will show Bob s Warehouse corporate information, checking box 2c ( Person on whose behalf transaction was conducted ) and Check if entity, and inserting in item 21 the deposited amount ($21,000) and Bob s Warehouse account number.

3 Part I (2 of 2) will show ACS One s corporate information, checking boxes 2d ( Courier service (private) ) and Check if entity, and inserting in item 21 the amount delivered by ACS One on behalf of Bob s Warehouse ($21,000) and Bob s Warehouse account number. Part II will show the $21,000 deposited in section 25a. Part III will contain Bank A s information as the financial institution where transaction took place. The completed CTR is shown on pages 10 through 14 of this guidance. Even though ACS One made a currency delivery of $21,000 acting on behalf of a person other than Bank A, no separate CTRs need to be filed on ACS One s delivery. Currency Transaction ReportWARNING: PRINTED VERSIONS OF THE BSA E-FILING FORMS ARE NOT FOR SUBMISSION AND WILL NOT BE PROCESSED BY NameACS Delivery O/B FI ( ) Transaction Report Version Number:By providing my PIN, I acknowledge that I am electronically signing the BSA report submitted.

4 Correct/amend prior reportInitial reportFinCEN directed BackfilingDocument Control Number / BSA Identifier*1 Type of filing Sign with PINOMB No. 1506-0064 Page 2 of 4 Currency Transaction ReportWARNING: PRINTED VERSIONS OF THE BSA E-FILING FORMS ARE NOT FOR SUBMISSION AND WILL NOT BE PROCESSED BY FinCEN . Part I Person Involved in Transaction of+-11 *2 Person conducting transaction on own behalfPerson conducting transaction for anotherPerson on whose behalf transaction was conductedCourier Service (private)dcb 3 Multiple transactionsa *4 Individual's last name or entity's legal nameIf entityUnknownJack's Restaurant Check *5 First nameUnknown 6 Middle name 7 Gender Suffix 8 Alternate Name 9 Occupation or type of business Food Service Business 9a NAICS Code722 Unknown123 Nice Lane *10 AddressUnknownWashingtonUnknownUnknown20 005 Unknown *11 City *12 State *14 CountryDCUS*13 ZIP/Postal CodeUnknown456123987 Unknown *15 TIN *17 Date of birth 16 TIN typeEIN 18 Contact phone number2023536900 Ext.

5 19 E-mail address *20 Form of identification used to verify identityUnknown Driver's license/State ID Passport Alien Registration OtherBusiness LicsenseNumberDC123456 Issuing StateDCCountry US21 Cash in amount for individual or entity listed in Item 4 $21,000 Account number 123654-+22 Cash out amount for individual or entity listed in Item 4 $ Account number +-Page 3 of 4 Currency Transaction ReportHomeWARNING: PRINTED VERSIONS OF THE BSA E-FILING FORMS ARE NOT FOR SUBMISSION AND WILL NOT BE PROCESSED BY II Amount and Type of Transaction(s). Check all boxes that apply. 24 *23 Date of transaction11/08/2012 Armored car (FI Contract)ATMMail Deposit or ShipmentNight DepositAggregated transactions*25 CASH IN: (in dollar equivalent)a Deposit(s) $21, Payment(s).

6 00c Currency received for funds transfer(s) Purchase of negotiable instrument (s).00e Currency exchange(s).00f Currency to prepaid Purchases of casinos chips, tokens and other gaming Currency wager(s) including money Bills inserted into gaming Other (specify):.00 Total Cash in $21, *27 CASH OUT: (in dollar equivalent)a Withdrawal(s) $.00b Advance(s) on credit (including markers) .00c Currency paid from funds transfer(s) in .00d Negotiable instrument(s) Currency exchange(s).00f Currency from prepaid Redemption(s) of casino chips, tokens, TITO tickets and other gaming instruments .00h Payment(s) on wager(s) (including race and OTB or sports pool).00i Travel and complimentary expenses and book gaming Payment for tournament, contest or other Other (specify).

7 00 Total Cash out $.0026 Foreign Cash in -+Foreign Country28 Foreign Cash out -+Foreign CountryPage 4 of 4 Currency Transaction ReportWARNING: PRINTED VERSIONS OF THE BSA E-FILING FORMS ARE NOT FOR SUBMISSION AND WILL NOT BE PROCESSED BY III Financial Institution Where Transaction(s) Takes Place of -+11 *37 Type of financial institutionDepository institution Other (specify) *29 Primary federal regulatorOffice of the Comptroller of the Currency (OCC) 38 If 37a - Casino/Card Club is checked, indicate type (check only one) State licensed casinoTribal authorized casinoCard club Other *30 Legal name of financial institutionBank A 31 Alternate name, trade name, DBA *32 EIN112323366*33 Address1000 14th Street NW *35 StateDC*36 ZIP Code20005 *34 CityWashington ID number12365422 39 Financial institution ID typeResearch, Statistics, Supervision and Discount (RSSD) number *40 Contact officeCompliance *41 Phone number2024563100 Ext.

8 *42 Date Filed(Date filed will be auto-populated when the form is signed.)Currency Transaction ReportWARNING: PRINTED VERSIONS OF THE BSA E-FILING FORMS ARE NOT FOR SUBMISSION AND WILL NOT BE PROCESSED BY NameACS Del. O/B Customer ( ) Transaction Report Version Number:By providing my PIN, I acknowledge that I am electronically signing the BSA report submitted. Correct/amend prior reportInitial reportFinCEN directed BackfilingDocument Control Number / BSA Identifier*1 Type of filing Sign with PINOMB No. 1506-0064 Page 2 of 5 Currency Transaction ReportWARNING: PRINTED VERSIONS OF THE BSA E-FILING FORMS ARE NOT FOR SUBMISSION AND WILL NOT BE PROCESSED BY FinCEN . Part I Person Involved in Transaction of+-12 *2 Person conducting transaction on own behalfPerson conducting transaction for anotherPerson on whose behalf transaction was conductedCourier Service (private)dcb 3 Multiple transactionsa *4 Individual's last name or entity's legal nameIf entityUnknownBob's Warehouse Check *5 First nameUnknown 6 Middle name 7 Gender Suffix 8 Alternate Name 9 Occupation or type of businessStorage Facility 9a NAICS Code493 Unknown123 Nice Lane *10 AddressUnknownWashingtonUnknownUnknown20 005 Unknown *11 City *12 State *14 CountryDCUS*13 ZIP/Postal CodeUnknown456123987 Unknown *15 TIN *17 Date of birth 16 TIN typeEIN 18 Contact phone number2023536900 Ext.

9 19 E-mail address *20 Form of identification used to verify identityUnknown Driver's license/State ID Passport Alien Registration OtherBusiness LicsenseNumberDC123456 Issuing StateDCCountry US21 Cash in amount for individual or entity listed in Item 4 $21,000 Account number 123654-+22 Cash out amount for individual or entity listed in Item 4 $ Account number +-Page 3 of 5 Currency Transaction ReportWARNING: PRINTED VERSIONS OF THE BSA E-FILING FORMS ARE NOT FOR SUBMISSION AND WILL NOT BE PROCESSED BY FinCEN . Part I Person Involved in Transaction of+-22 *2 Person conducting transaction on own behalfPerson conducting transaction for anotherPerson on whose behalf transaction was conductedCourier Service (private)dcb 3 Multiple transactionsa *4 Individual's last name or entity's legal nameIf entityUnknownArmored Car Service One Check *5 First nameUnknown 6 Middle name 7 Gender Suffix 8 Alternate Name 9 Occupation or type of businessArmored Car Service 9a NAICS Code4921 Unknown55 West Street *10 AddressUnknownWashingtonUnknownUnknown20 010 Unknown *11 City *12 State *14 CountryDCUS*13 ZIP/Postal CodeUnknown654329874 Unknown *15 TIN *17 Date of birth 16 TIN typeEIN 18 Contact phone number2025551212 Ext.

10 19 E-mail address *20 Form of identification used to verify identityUnknown Driver's license/State ID Passport Alien Registration OtherBusiness LicenseNumberDC12456 Issuing StateDCCountry US21 Cash in amount for individual or entity listed in Item 4 $21,000 Account number -+22 Cash out amount for individual or entity listed in Item 4 $ Account number +-Page 4 of 5 Currency Transaction ReportHomeWARNING: PRINTED VERSIONS OF THE BSA E-FILING FORMS ARE NOT FOR SUBMISSION AND WILL NOT BE PROCESSED BY II Amount and Type of Transaction(s). Check all boxes that apply. 24 *23 Date of transaction11/08/2012 Armored car (FI Contract)ATMMail Deposit or ShipmentNight DepositAggregated transactions*25 CASH IN: (in dollar equivalent)a Deposit(s) $21, Payment(s).