WARNING: PRINTED VERSIONS OF THE BSA E-FILING FORMS ARE NOT FOR SUBMISSION

EFTA01291973 Dataset 10 5 pages Download original PDF Download as text
WARNING: PRINTED VERSIONS OF THE BSA E-FILING FORMS ARE NOT FOR SUBMISSION AND WILL NOT BE PROCESSED BY FINCEN. Currency Transaction Report OMB No. 1506-0064 Filing Name 152-6426 Version Number 1.1 9 Type of filing Minitel report ❑ Correct ia mend prior report ❑ FinCEN directed Backfiling Document Control Number / BSA Identifier L Save Validate Print Under penalties of perjury. I declare that I have examined this transmittal, including accompanying documents, and to the best of my knowledge and belief it is correct and complete. In the case of documents without recipients identifying numbers, I have complied with the requirements of the law in attempting to secure such numbers from the receipts. I declare that this filing represents all Documents filed during this reporting period except for those transactions reported on paper. Sign with PIN SDNY_GM_00049899 CONFIDENTIAL — PURSUANT TO FED. R.QQN(FIDENTIAL DB-SONY-0012723 EFTA_OOI 60507 EFTA01291973 WARNING: 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 1 of 2 00 ri Person conducting .2 a " transaction on own behalf 3 O Multiple transactions Person conducting Person on whose behalf b transaction for another c I—I transaction was conducted d O Courier Service (Private) Check O If entity '4 Individual's last name O Unknown or entity's legal name '5 First name O Unknown 6 Middle name Suffix 7 Gender 8 Alternate Name 9 Occupation or type of business Indyke Darren K. Male Attorney; owner of law arm 9a NAICS Code '10 Address '11 City •12 State '14 Country '15 TIN '17 Date of birth 18 Contact phone number 19 E-mail address O Unknown O Unknown ❑ Unknown O Unknown 0 Unknown ❑ Unknown [ '13 ZIP/Postal 16 TIN type Ext. Code 0 Unknown • US SSN4TIN '20 Form of identification used to verify identity Number OUnknown IX Drivers kcense/State ID O Passport O Alien Registration O Other Country US 21 Cash in amount for individual or entity listed in Item 4 Account number Issuing State • 22 Cash out amount for irxlmdual or entity listed in Item 4 $ 108.778 Account number)00 1 0 • Page 2 of 5 SDNY_GM_00049900 CONFIDENTIAL - PURSUANT TO FED. R.QQN(FIDENTIAL DB-SONY-00 12724 EFTA_00 I 60508 EFTA01291974 WARNING: PRINTED VERSIONS OF THE BSA E-FILING FORMS ARE NOT FOR SUBMISSION AND WILL NOT BE PROCESSED BY FINCEN. Part 1 Person Involved in Transaction 2 of 2 00 O '2 a rn Person conducting Person conducting — Person on whose behalf b I—I transaction on own behalf transa ction for another c El transaction was conducted d ❑ C°tirier Service (dr".) 3 O Multiple transactions Check O If entity '4 Individuars last name O Unknown or entitys legal name '5 First name O Unknown 6 Middle name Suffix 7 Gender 8 Alternate Name Epstein Jeffrey 9 Occupation or type of business 1 President of SouthemFInancial 9a NAICS Code '10 Address O Unknown —It City '12 State 6100 Red Hook Quarter, B3 O Unknown [ St. Thomas ----------- O Unknown VI '14 Count!), O Unknown '15 TIN ❑ Unknown '17 Date of birth ❑ Unknown 18 Contact phone number 19 E-mail address '20 Form of identification used to verify identity US 0112011963 '13 ZIP/Postal Code O Unknown [00802 18 TIN type Ext. SSN4TIN Number OUnknown ig Drivers kcense/State II) O Passport O Alien Registration O Other C000000029913 Country US 21 Cash in amount for individual or entity listed in Item 4 Account number Issuing State VI 22 Cash out amount for Individual or entity listed in Item 4 108.778 Account number [ 0 0 1 0 0 Page 3 of 5 SDNY_GM_00049901 CONFIDENTIAL - PURSUANT TO FED. R.QQN(FIDENTIAL DB-SONY-00 12725 EFTA_00I60509 EFTA01291975 WARNING: PRINTED VERSIONS OF THE BSA E-FILING FORMS ARE NOT FOR SUBMISSION AND WILL NOT BE PROCESSED BY FINCEN. Part II Amount and Type of Transaction(s). Check all boxes that apply. '23 Date of transaction 01117/201S 24 O Aimored car (FI Contract) O ATM ❑ Mail Deposit or Shipment O Night Deposit O Aggregated transactions 15 CASH IN: (in U.S. dollar equivalent) '27 CASH OUT: PO U.S. dollar ItquNalent) a Deposit(s) .00 a Ildthdrawal(s) .00 b Payment(s) .00 b Advance(s) C Cestency on credit (Including markers) .00 c Currency received for funds translor(s) out .00 pail from funds transfot(s) n .00 d Purchase of negotiable instrument (s) .00 d Negotiable instrument(s) cashed 100.000,00 e Currency orchange(s) 00 e Currency exchange(%) 8,778.00 f Currency to prepaid access .00 I Currency from prepaid access .00 g Purchases of casinos chile, tokens Redemploo(s) or casino chips. tokens, and other gaming instruments 00 TITO tickets and other gaming instruments 00 h Currency vrage(s) including h Payments) on race(s) roductem moo money plays .00 and OTB or sports goon .00 Travel and complimentary expenses and I Bills inserted into gaming devices .00 took gaming Incentives .00 Payment ler tournament. contest or other z Other (speedy): promotions .00 .00 z Other (specify) .00 Total Cash in .00 Total Cash out 108,77100 26 Foreign Cash in Foreign Country 0 0 28 Foreign Cash out 7,000 Foreign Country 0 0 BE Page 4 of 5 SDNY_GM_00049902 CONFIDENTIAL - PURSUANT TO FED. R.QPN(EIDENTIAL DB-SONY-00 12726 EFTA_00 I 605 I 0 EFTA01291976 WARNING: PRINTED VERSIONS OF THE BSA E-FILING FORMS ARE NOT FOR SUBMISSION AND WILL NOT BE PROCESSED BY FINCEN. Part III Financial Institution Where Transaction(s) Takes Place 1 of 1 0 0 '37 Type of financial institution I Depository institution Other (specify) '29 Primary federal regulator I Federal Reserve Board (FRB) 38 If 37a - Casino/Card Club is checked, indicate type (chedc only one) ❑ State licensed casino ❑ Tribal authorized casino El Card club ❑ Other '30 Legal name of financial institubon I Deutsche Bank Trust Company Americas 31 Alternate name, e.g. trade name, DBA '32 EIN '33 Address '34 City '35 State 346 Park Ave New York NY '36 ZIP Code 110154 39 Financial institution ID type ID number '40 Contact office '41 Phone number '42 Date Filed DB PB AML (Dale filed will be auto-populated when Ihe form is signed.) Page 5 of 5 SDNY_GM_00049903 CONFIDENTIAL - PURSUANT TO FED. R.CON(FIDENTIAL DB-SONY-00 12727 EFTA_00I605 I I EFTA01291977

📷 Images in this document (5 detected)

AI-generated factual descriptions of embedded images (llava:13b). These are searchable across the corpus.

[Image 1] The image shows a document with a header that reads "CONFIDENTIAL." Below the header, there is a form with various fields to be filled out, including sections for "To," "From," "Subject," and "Date." The form includes checkboxes for "Confidential," "Personal," and "Sensitive." There are also fields for "Name," "Address," "City," "State," "Zip Code," "Country," "Phone Number," "Email," and "Fax Num [Image 2] The image shows a document with a header that reads "CONFIDENTIAL." The document appears to be a form or a checklist with various fields to be filled out. There are checkboxes for "I certify that the information provided is true and correct," "I understand that the information provided will be used for the purpose of evaluating my application," and "I understand that the information provided may b [Image 3] The image shows a document that appears to be a form or a checklist. It is a black and white scan, and there are several sections with checkboxes and fields for writing. The form includes headings such as "WARNING: Do not remove this page," "CONFIDENTIAL," and "CONFIDENTIAL." There are checkboxes for "I have read and understand the contents of this form," and there are fields for the date, the nam [Image 4] The image shows a document titled "Currency Transaction Report." It appears to be a form or template used for reporting currency transactions, possibly for accounting or regulatory purposes. The form includes fields for the date, sender's name, recipient's name, and various details about the transaction, such as the type of currency, the amount, and the purpose of the transaction. There are checkb [Image 5] The image shows a document with a header that reads "CONFIDENTIAL." Below the header, there is a form with various fields to be filled out, including "Name," "Address," "City," "State," "Zip Code," "Phone Number," "Email Address," "Date," and "Signature." The form appears to be a financial transaction form, possibly for a bank or financial institution. The fields are blank, indicating that the for