FinCEN Form 104 "Currency Transaction Report"

FinCEN Form 104 Printable Pdf
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What Is FinCEN Form 104?

This is a legal form that was released by the U.S. Department of the Treasury - Financial Crimes Enforcement Network on March 1, 2011 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2011;
  • The latest available edition released by the U.S. Department of the Treasury - Financial Crimes Enforcement Network;
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  • Fill out the form in our online filing application.

Download a fillable version of FinCEN Form 104 by clicking the link below or browse more documents and templates provided by the U.S. Department of the Treasury - Financial Crimes Enforcement Network.

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Download FinCEN Form 104 "Currency Transaction Report"

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Currency Transaction Report
104
FINCEN Form
Previous editions will not be accepted after September, 2011.
(March 2011)
Please type or print.
Department of the Treasury
(Complete all parts that apply--See Instructions)
FinCEN
OMB No. 1506-0004
1
Check all box(es) that apply:
a
Amends prior report
b
Multiple persons
c
Multiple transactions
Part I
Person(s) Involved in Transaction(s)
Section A--Person(s) on Whose Behalf Transaction(s) Is Conducted
2 Individual’s last name or entity’s name
3 First name
4 Middle initial
5 Doing business as (DBA)
6 SSN or EIN
7 Address (number, street, and apt. or suite no.)
8 Date of birth
____/____/_______
MM
DD
YYYY
10 State 11 ZIP code
12 Country code
9 City
13 Occupation, profession, or business
(if not U.S.)
14 If an individual, describe method used to verify identity:
b
Passport
a
Driver’s license/State I.D.
c
Alien registration
e Issued by:
d
Other
f Number:
Section B--Individual(s) Conducting Transaction(s) (if other than above).
If Section B is left blank or incomplete, check the box(es) below to indicate the reason(s)
b
Mail Deposit or Shipment
c
Night Deposit or Automated Teller Machine
d
Multiple Transactions
e
Conducted On Own Behalf
a
Armored Car Service
15 Individual’s last name
16 First name
17 Middle initial
18 Address (number, street, and apt. or suite no.)
19 SSN
20 City
21 State
22 ZIP code
24 Date of birth
23 Country code
____/____/_______
(If not U.S.)
MM
DD
YYYY
25 If an individual, describe method used to verify identity:
a
Driver’s license/State I.D.
b
Passport
c
Alien registration
e Issued by:
f Number:
d
Other
Part II
Amount and Type of Transaction(s). Check all boxes that apply.
28 Date of transaction
0
0
26
Total cash in $
.00
____/____/_______
27
Total cash out $
.00
MM
DD
YYYY
0
0
26a
Foreign cash in
.00
27a Foreign cash out
.00
(see instructions, page 4)
(see instructions, page 4)
29
Foreign Country
30
Wire Transfer(s)
31
Negotiable Instrument(s) Purchased
34
Deposit(s)/Withdrawal(s)
33
Currency Exchange(s)
32
Negotiable Instrument(s) Cashed
35
Account Number(s) Affected (if any):
36
Other (specify)
Part III
Financial Institution Where Transaction(s) Takes Place
Enter Regulator or BSA
37 Name of financial institution
Examiner code number
(see instructions)
38 Address (number, street, and apt. or suite no.)
39 EIN or SSN
41 State
42 ZIP code
43 Routing (MICR) number
40 City
44 Title of approving official
45 Signature of approving official
46 Date of signature
____/____/_______
Sign
MM
DD
YYYY
47 Type or print preparer’s name
48 Type or print name of person to contact
49 Telephone number
Here
(
)
FinCEN Form 104 (Rev. 03-2011)
For Paperwork Reduction Act Notice, see page 4.
Cat. No. 37683N
Currency Transaction Report
104
FINCEN Form
Previous editions will not be accepted after September, 2011.
(March 2011)
Please type or print.
Department of the Treasury
(Complete all parts that apply--See Instructions)
FinCEN
OMB No. 1506-0004
1
Check all box(es) that apply:
a
Amends prior report
b
Multiple persons
c
Multiple transactions
Part I
Person(s) Involved in Transaction(s)
Section A--Person(s) on Whose Behalf Transaction(s) Is Conducted
2 Individual’s last name or entity’s name
3 First name
4 Middle initial
5 Doing business as (DBA)
6 SSN or EIN
7 Address (number, street, and apt. or suite no.)
8 Date of birth
____/____/_______
MM
DD
YYYY
10 State 11 ZIP code
12 Country code
9 City
13 Occupation, profession, or business
(if not U.S.)
14 If an individual, describe method used to verify identity:
b
Passport
a
Driver’s license/State I.D.
c
Alien registration
e Issued by:
d
Other
f Number:
Section B--Individual(s) Conducting Transaction(s) (if other than above).
If Section B is left blank or incomplete, check the box(es) below to indicate the reason(s)
b
Mail Deposit or Shipment
c
Night Deposit or Automated Teller Machine
d
Multiple Transactions
e
Conducted On Own Behalf
a
Armored Car Service
15 Individual’s last name
16 First name
17 Middle initial
18 Address (number, street, and apt. or suite no.)
19 SSN
20 City
21 State
22 ZIP code
24 Date of birth
23 Country code
____/____/_______
(If not U.S.)
MM
DD
YYYY
25 If an individual, describe method used to verify identity:
a
Driver’s license/State I.D.
b
Passport
c
Alien registration
e Issued by:
f Number:
d
Other
Part II
Amount and Type of Transaction(s). Check all boxes that apply.
28 Date of transaction
0
0
26
Total cash in $
.00
____/____/_______
27
Total cash out $
.00
MM
DD
YYYY
0
0
26a
Foreign cash in
.00
27a Foreign cash out
.00
(see instructions, page 4)
(see instructions, page 4)
29
Foreign Country
30
Wire Transfer(s)
31
Negotiable Instrument(s) Purchased
34
Deposit(s)/Withdrawal(s)
33
Currency Exchange(s)
32
Negotiable Instrument(s) Cashed
35
Account Number(s) Affected (if any):
36
Other (specify)
Part III
Financial Institution Where Transaction(s) Takes Place
Enter Regulator or BSA
37 Name of financial institution
Examiner code number
(see instructions)
38 Address (number, street, and apt. or suite no.)
39 EIN or SSN
41 State
42 ZIP code
43 Routing (MICR) number
40 City
44 Title of approving official
45 Signature of approving official
46 Date of signature
____/____/_______
Sign
MM
DD
YYYY
47 Type or print preparer’s name
48 Type or print name of person to contact
49 Telephone number
Here
(
)
FinCEN Form 104 (Rev. 03-2011)
For Paperwork Reduction Act Notice, see page 4.
Cat. No. 37683N
FinCEN Form 104 (Ef f . 03-2011)
Page 2
Multiple Persons
Complete applicable parts below if box 1b on page 1 is checked
Part I
Person(s) Involved in T ransaction(s)
Section A--Person(s) on Whose Behalf T ransaction(s) Is Conducted
2 Individual’s last name or entity’s name
3 First name
4 Middle initial
5 Doing business as (DBA)
6 SSN or EIN
7 Address (number, street, and apt. or suite no.)
8 Date of birth
____/____/_______
MM
DD
YYYY
9 City
10 State
11 ZIP code
12 Country code
13 Occupation, profession, or business
(if not U.S.)
14 If an individual, describe method used to verify identity:
b
Passport
a
Driver’s license/State I.D.
c
Alien registration
e Issued by:
d
Other
f
Number:
Section B--Individual(s) Conducting T ransaction(s) (if other than above).
15 Individual’s last name
17 Middle initial
16 First name
18 Address (number, street, and apt. or suite no.)
19 SSN
24 Date of birth
20 City
21 State
22 ZIP code
23 Country code
____/____/_______
(if not U.S.)
MM
DD
YYYY
25 If an individual, describe method used to verify identity:
b
Passport
c
Alien registration
a
Driver’s license/State I.D.
e Issued by:
f Number:
d
Other
Part I
Person(s) Involved in T ransaction(s)
Section A--Person(s) on Whose Behalf T ransaction(s) Is Conducted
2 Individual’s last name or entity’s name
3 First name
4 Middle initial
5 Doing business as (DBA)
6 SSN or EIN
7 Address (number, street, and apt. or suite no.)
8 Date of birth
____/____/_______
MM
DD
YYYY
10 State
11 ZIP code
12 Country code
13 Occupation, profession, or business
9 City
(if not U.S.)
14 If an individual, describe method used to verify identity:
b
Passport
a
Driver’s license/State I.D.
c
Alien registration
f
Number:
d
Other
e Issued by:
Section B--Individual(s) Conducting T ransaction(s) (if other than above).
15 Individual’s last name
17 Middle initial
16 First name
18 Address (number, street, and apt. or suite no.)
19 SSN
24 Date of birth
20 City
21 State
22 ZIP code
23 Country code
____/____/_______
(if not U.S.)
MM
DD
YYYY
25 If an individual, describe method used to verify identity:
a
Driver’s license/State I.D.
b
Passport
c
Alien registration
e Issued by:
f
Number:
d
Other
Page 3
FinCEN Form 104 (Eff. 03-2011)
Suspicious Transactions
document(s). Acceptable forms of identification include
PART I - Person(s) Involved in Transaction(s)
driver’s license, military and military/dependent
This Currency Transaction Report (CTR) should NOT be
identification cards, passport, state issued identification
Section A must be completed. If an individual conducts a
filed for suspicious transactions involving $10,000 or less
card, cedular card (foreign), non-resident alien identification
transaction on his own behalf, complete Section A and
in currency OR to note that a transaction of more than
cards, or any other identification document
leave Section “B” BLANK. If an individual conducts a
$10,000 is suspicious. Any suspicious or unusual activity
or documents, which contain name and preferably address
transaction on his own behalf and on behalf of another
and a photograph and are normally acceptable by financial
should be reported by a financial institution in the manner
person(s), complete Section “A” for each person and leave
prescribed by its appropriate federal regulator or BSA
institutions as a means of identification when cashing checks
Section “B” BLANK. If an individual conducts a
for persons other than established customers.
examiner. (See the instructions for Item 37). If a transaction
transaction on behalf of another person(s), complete Section
is suspicious and in excess of $10,000 in currency, then
“B” for the individual conducting the transaction, and
Acceptable identification information obtained previously
both a CTR and the appropriate Suspicious Activity Report
complete Section “A” for each person on whose behalf the
form must be filed.
and maintained in the financial institution’s records may be
transaction is conducted of whom the financial institution
used. For example, if documents verifying an individual’s
has knowledge.
In situations involving suspicious transactions requiring
identity were examined and recorded on a signature card
when an account was opened, the financial institution may
immediate attention, such as when a reportable transaction
Section A. Person(s) on Whose Behalf Transaction(s)
is ongoing, the fianacial institution shall immediately notify,
rely on that information. In completing the CTR, the
Is Conducted. See instructions above.
financial institution must indicate on the form the method,
by telephone, appropriate law enforcement and regulatory
authorities in addition to filing a timely suspicious activity
type, and number of the identification. Statements such as
Items 2, 3, and 4. Individual/Organization Name. If
report.
“known customer” or “signature card on file” are not
the person on whose behalf the transaction(s) is conducted
sufficient for form completion.
is an individual, put his/her last name in Item 2, first name
General Instructions
in Item 3, and middle initial in Item 4. If there is no
Penalties. Civil and criminal penalties are provided for
middle initial, leave item 4 BLANK. If the transaction is
Who Must File. Each financial institution (other than a
failure to file a CTR or to supply information or for filing a
conducted on behalf of an entity, enter the name in Item 2
casino, which instead must file FinCEN Form 103, and the
false or fraudulent CTR. See 31 U.S.C. 5321, 5322 and
and leave Items 3 and 4 BLANK.
U.S. Postal Service for which there are separate rules) must
5324.
file FinCEN Form 104 (CTR) for each deposit, withdrawal,
Item 5. Doing Business As (DBA). If the financial
exchange of currency, or other payment or transfer, by,
For purposes of this CTR, the terms below have the
institution has knowledge of a separate “doing business
following meanings:
through, or to the financial institution which involves a
as” name, enter it in Item 5. For example, if Smith
transaction in currency of more than $10,000. Multiple
Enterprise is doing business as MJ’s Pizza, enter “MJ’s
Currency. The coin and paper money of the United States
transactions must be treated as a single transaction if the
Pizza” in item 5.
or any other country, which is circulated and customarily
financial institution has knowledge that (1) they are by or
used and accepted as money.
on behalf of the same person, and (2) they result in either
Item 6. SSN or EIN. Enter the Social Security Number
currency received (Cash In) or currency disbursed (Cash
Person. An individual, corporation, partnership, trust or
(SSN) or Individual Taxpayer Identification Number (ITIN)
Out) by the financial institution totaling more than $10,000
estate, joint stock company, association, syndicate, joint
or Employer Identification Number (EIN) of the person or
during any one business day. For a bank, a business day is
venture or other unincorporated organization or group.
entity identified in Item 2. If none, leave blank.
the day on which transactions are routinely posted to
customers’ accounts, as normally communicated to
Organization. Entity other than an individual.
Items 7, 9, 10, 11, and 12. Address. Enter the permanent
depository customers. For all other financial institutions,
address including ZIP Code of the person identified in Item
a business day is a calendar day.
Transaction in Currency. The physical transfer of currency
2. Use the U.S. Postal Service’s two letter state abbreviation
from one person to another. This does not include a transfer
code. A P. O. Box should not be used by itself, and may
Generally, financial institutions are defined as banks, other
of funds by means of bank check, bank draft, wire transfer or
only be used if there is no street address. If a P. O. Box is
types of depository institutions, brokers or dealers in
other written order that does not involve the physical transfer
used, the name of the apartment or suite number, road or
securities, money transmitters, currency exchangers, check
of currency.
route number where the person resides must also be provided.
cashers, and issuers and sellers of money orders and traveler’s
If the address is outside the U.S., provide the street address,
checks. Should you have questions, see the definitions in
Negotiable Instruments. All checks and drafts (including
city, province or state, postal code (if known), and the two
31 CFR Chapter X.
business, personal, bank, cashier’s and third-party), money
letter country code. For country code list go to
orders, and promissory notes. For purposes of this CTR,
www.fincen.gov/reg_bsaforms.html or telephone 800-949-
When and Where To File. This form should be e-filed
all traveler’s checks shall also be considered negotiable
2732 and select option number 5. If U.S., leave item 12
through the Bank Secrecy Act E-filing System. Go to
instruments whether or not they are in bearer form.
blank.
http: //bsaefiling.fincen.treas.gov/index.jsp to register.
This form is also available for download on the Financial
Foreign exchange rate.
If foreign currency is a part of a
Item 8. Date of Birth. Enter the date of birth. Eight
Crimes Enforcement Network’s Web site at www.fincen.gov,
currency transaction that requires the completion of a
numerals must be inserted for each date. The first two will
or may be ordered by calling the IRS Forms Distribution
CTR, use the exchange rate in effect for the business day
reflect the month, the second two the day, and the last four
Center at (800) 829-3676. File this CTR by the 15th
of the transaction to compute the amount, in US dollars,
the year. A zero (0) should precede any single digit number.
calendar day after the day of the transaction with the:
to enter in item 26/27.
The source of the exchange rate that
For example, if an individual’s birth date is April 3 1948,
is used will be determined by the reporting institution.
Item 8 should read 04 03 1948.
Enterprise Computing Center - Detroit
ATTN: CTR
Specific Instructions
Item 13. Occupation, profession, or business . If known,
P.O. Box 33604
Because of the limited space on the front and back of the
identify the occupation, profession or business that best
Detroit, MI 48232-5604
CTR, it may be necessary to submit additional information
describes the individual or entity in Part I (e.g., attorney,
on attached sheets. Submit this additional information on
car dealer, carpenter, doctor, farmer, plumber, truck driver,
Keep a copy of each CTR for five years from the date filed.
plain paper attached to the CTR. Be sure to put the
etc.). Do not use nondescript terms such as businessman,
individual’s or entity’s name and identifying number (items
merchant, store owner (unless store’s name is provided), or
A financial institution may apply to file the CTRs
2, 3, 4, and 6 of the CTR) on any additional sheets so that
self employed. If unemployed, or retired are used enter the
electronically. To obtain an application to file
if it becomes separated, it may be associated with the CTR.
regular or former occupation if known.
electronically, contact the Bank Secrecy Act E-filing
System. Go to http: //bsaefiling.fincen.treas.govindex.jsp
Item 1a. Amends Prior Report. If this CTR is being filed
Item 14. If an Individual, Describe Method Used To
to register or contact the
BSA E-Filing Help Desk at 1-
because it amends a report filed previously, check Item 1a.
888-827-2778 (select option # 6) or via email at
Staple a copy of the original CTR to the amended one,
Verify Identity. If an individual conducts the transaction(s)
complete Part III fully and only those other entries which
on his/her own behalf, his/her identity must be verified by
BSAEFilingHelp@notes.tcs.treas.gov.
are being amended.
examination of an acceptable document (see General
Instructions). For example, check box a if a driver’s license
Item 1b. Multiple Persons. If this transaction is being
is used to verify an individual’s identity, and enter the state
Identification Requirements. All individuals (except a
conducted by more than one person or on behalf of more
that issued the license and the number in items e and f. If
employees of armored car services) conducting a reportable
than one person, check Item 1b. Enter information in Part
the transaction is conducted by an individual on behalf of
transaction(s) for themselves or for another person, must be
I for one of the persons and provide information on any
another individual not present, or on behalf of an entity,
identified by means of an official
other persons on the back of the CTR.
check box “14d” “Other” and enter “NA” on the line
provided.
Item 1c. Multiple Transactions. If the financial institution
has knowledge that there are multiple transactions, check
Item 1c.
Page 4
FinCEN Form 104 (Eff. 03-2011)
Section B. Individual(s) Conducting Transaction(s)
If there is a currency exchange, it should be aggregated
purchase “foreign currency.” If
multiple (more than one)
(if other than above). Financial institutions should enter
separately with each of the Cash In and Cash Out totals.
foreign currencies are involved in the transaction, enter the
as much information as is available. However, there may
amount of the largest foreign currency transaction in item
be instances in which Items 15-25 may be left BLANK or
Example 1: A person deposits $11,000 in currency to his
26a or 27a and that currency’s country-code of origin in
incomplete. If Items 15-25 are left BLANK or incomplete,
savings account and withdraws $3,000 in currency from
item 29. Then check box 36 and enter the additional
check one or more of the boxes provided to indicate the
his checking account. The CTR should be completed as
foreign currencies amount(s) and country-code(s) of origin
reasons.
follows:
in the space provided.
Cash In $11,000 and no entry for Cash Out. This is
Example: If there are multiple transactions that, if only
because the $3,000 transaction does not meet the reporting
PART III - Financial Institution Where Transaction(s)
when aggregated, the financial institution has knowledge
threshold.
Take Place
the transactions exceed the reporting threshold, and therefore,
did not identify the transactor(s), check box d for Multiple
Example 2: A person deposits $11,000 in currency to his
Item 37. Name of Financial Institution and Identity of
Transactions.
savings account and withdraws $12,000 in currency from
Regulator or BSA Examiner. Enter the financial
his checking account. The CTR should be completed as
institution’s full legal name and identify the regulator or
Items 15, 16, and 17. Individual’s Name. Complete
follows:
BSA examiner, using the following codes:
these items if an individual conducts a transaction(s) on
Cash In $11,000, Cash Out $12,000. This is because
behalf of another person. For example, if John Doe, an
there are two reportable transactions. However, one CTR
Regulator
or
BSA
Examiner
employee of XY Grocery Store, makes a deposit to the
may be filed to reflect both.
CODE
store’s account, XY Grocery Store should be identified in
Comptroller of the Currency (OCC).........................1
Section A and John Doe should be identified in section B.
Federal Deposit Insurance Corporation (FDIC)...........2
Example 3: A person deposits $6,000 in currency to his
Federal Reserve System (FRS)................................3
savings account and withdraws $4,000 in currency from
Items 18, 20, 21, 22, and 23. Address. Enter the permanent
Office of Thrift Supervision (OTS)...........................4
his checking account. Further, he presents $5,000 in
street address including ZIP Code of the individual. (See
National Credit Union Administration (NCUA)..........5
currency to be exchanged for the equivalent in Euro’s. The
the instructions for Items 7 and 9 through 12.) Enter country
Securities and Exchange Commission (SEC).............6
CTR should be completed as follows:
code if not U.S. (Reference item 12).
Internal Revenue Service (IRS)................................7
Cash In $11,000 and no entry for Cash Out. This is
U.S. Postal Service (USPS)....................................8
because in determining whether the transactions are
Item 19. SSN/ITIN. If the individual has a Social Security
Commodity Futures Trading Commission (CFTC).....9
reportable, the currency exchange is aggregated with each
State Regulator.....................................................10
Number, or Individual Taxpayer Indentifcation Number,
of the Cash In and Cash Out amounts. The result is a
enter it in Item 19. If the individual does not have an SSN/
reportable $11,000 Cash In transaction. The total Cash
Items 38, 40, 41, and 42. Address. Enter the street
ITIN, enter NONE.
Out amount is $9,000, which does not meet the reporting
address, city, state, and ZIP Code of the financial institution
threshold. Therefore, it is not entered on the CTR.
where the transaction occurred. If there are multiple
Item 24. Date of Birth. Enter the individual’s date of
transactions, provide information of the office or branch
birth. (See the instructions for Item 8.)
Example 4: A person deposits $6,000 in currency to his
where any one of the transactions has occurred.
savings account and withdraws $7,000 in currency from
Item 25. If an Individual, Describe Method Used To
his checking account. Further, he presents $5,000 in
Item 39. EIN or SSN. Enter the financial institution’s
Verify Identity. Enter the method used to identify the
currency to be exchanged for the equivalent in Euro’s. The
EIN. If the financial institution does not have an EIN, enter
individual’s identity. (See General Instructions and the
CTR should be completed as follows:
the SSN of the financial institution’s principal owner.
instructions for Item 14.)
Cash In $11,000, Cash Out $12,000. This is because in
determining whether the transactions are reportable, the
Item 43. Routing (MICR) Number. If a depository
PART II - Amount and Type of Transaction(s)
currency exchange is aggregated with each of the Cash In
institution, enter the routing (Magnetic Ink Character
Complete Part II to identify the type of transaction(s) and
and Cash Out amounts. In this example, each of the Cash
Recognition (MICR)) number.
the amount(s) involved.
In and Cash Out totals exceed $10,000 and must be reflected
on the CTR.
SIGNATURE
Items 26 and 27. Total Cash In/Total Cash Out. In the
spaces provided, enter the total amount of currency received
Items 30-33. Check the appropriate item(s) to identify the
Items 44 and 45. Title and signature of Approving
(Total Cash In) or total currency disbursed (Total Cash
following type of transaction(s):
Official. The official who reviews and approves the CTR
Out) by the financial institution. If foreign currency is
30. Wire Transfer(s)
must indicate his/her title and sign the CTR.
exchanged, use the U.S. dollar equivalent on the day of the
31. Negotiable Instrument(s) Purchased
transaction (See “Foreign exchange rates”), and complete
32. Negotiable Instrument(s) Cashed
Item 46. Date of Signature. The approving official must
item 26a or 27a, whichever is appropriate.
33. Currency Exchange(s)
enter the date the CTR is signed. (See the instructions for
Item 8.)
If less than a full dollar amount is involved, increase that
Item 34. Deposits/Withdrawals. Check this item to
figure to the next highest dollar. For example, if the currency
identify deposits to or withdrawals from accounts, e.g.
Item 47. Preparer’s Name. Type or print the full name of
totals $20,000.05, show the total as $20,001.00.
demand deposit accounts, savings accounts, time deposits,
the individual preparing the CTR. The preparer and the
mutual fund accounts, or any other account held at the
approving official may not necessarily be the same
Items 26a and 27a. Foreign cash in/Foreign cash out. If
financial institution. Enter the account number(s) in Item
individual.
foreign currency is exchanged, enter the amount of foreign
35.
currency (Do not convert to U.S. dollars) in items 26a and
Items 48 and 49. Contact Person/Telephone Number.
27a. Report country of origin in item 29.
Item 35. Account Numbers Affected (if any). Enter the
Type or print the name and telephone number of an
account numbers of any accounts affected by the transactions
individual to contact concerning questions about the CTR.
Item 28. Date of Transaction. Insert eight numerals for
that are maintained at the financial institution conducting
each date. (See instructions for Item 8.)
the transaction(s).
Paperwork Reduction Act Notice. The requested information
is useful in criminal, tax, and regulatory investigations and
Item 29. Foreign Country. If items 26a and/or 27a are
proceedings. Financial institutions are required to provide
Example 1: If a person cashes a check drawn on an
completed indicating that foreign currency is involved,
the information under 31 U.S.C. 5313 and 31 CFR Chapter X,
account held at the financial institution, the CTR should
commonly referred to as the Bank Secrecy Act (BSA). The BSA
check Item 29 and identify the country. If multiple foreign
be completed as follows:
is administered by the U.S. Department of the Treasury’s
currencies are involved, check box 36 and identify the
Indicate negotiable instrument(s) cashed and provide the
Financial Crimes Enforcement Network (FinCEN). You are
additional country(s) and/or currency(s) involved.
account number of the check.
not required to provide the requested information unless a form
displays a valid OMB control number. The time needed to
Determining Whether Transactions Meet the
If the transaction does not affect an account, make no entry.
complete this form will vary depending on individual
Reporting Threshold.
circumstances. The estimated average time is 19 minutes. If you
Example 2: A person cashes a check drawn on another
have comments concerning the accuracy of this time estimate or
Only cash transactions that, if alone or when aggregated,
financial institution.
In this instance, negotiable
suggestions for making this form simpler, you may write to the
instrument(s) cashed would be indicated, but no account at
exceed $10,000 should be reported on the CTR.
Financial Crimes Enforcement Network, P. O. Box 39,
the financial institution has been affected. Therefore, Item
Transactions shall not be offset against one another.
Vienna, VA 22183. Do not send this form to this office. Instead,
35 should be left BLANK.
see When and Where to File in the instructions.
If there are both Cash In and Cash Out transactions that are
Item 36. Other (specify). If a transaction is not identified
reportable, the amounts should be considered separately
in Items 30-34, check Item 36 and provide an additional
and not aggregated. However, they may be reported on a
description. For example, a person presents a check to
single CTR.
U.S. Department of the Treasury - Financial Crimes Enforcement Network United States Federal Legal Forms United States Legal Forms

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FinCEN Form 104 Printable Pdf
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