EFTA Document EFTA01291931

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 152-5244 Version Number 1.1 '1 Type of filing Z Initial report K Corredsmend prior report K FinCEN directed Backfiling Document Control Number / BSA Identifier Save J 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_00049857 CONFIDENTIAL - PURSUANT TO FED. R.CON(F IDENTIAL DB-SDNY-0012681 EFTA_00160465 EFTA01291931 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 1 of 2 00 a K Person conducting Person conducting pvl Person on whose behalf b d K Courier Service (private) I—I transaction on own behalf transaction for another ® transaction was conducted 3 K Multiple transactions Check K If entity '4 Individuabs last name K Unknown or entilys legal name '5 First name K Unknown 6 Middle name Suffix 7 Gender 8 Alternate Name 9 Occupation or type of business Epstein Jeffrey Male 9a NAICS Code '10 Address '11 City '12 State '14 Country '5 TIN '17 Date of birth 18 Contact phone number 19 E-mail address K Unknown K Unknown I ❑Unknown K Unknown K Unknown K Unknown 6100 Red Hook quarter 83 ST. Thomas VI '13 ZIP/Postal 18 TIN type Ext. Code K Unknown I. US SSNJTIN 0112011963 '20 Form of identification used to verify identity Number Ei Unknown K Drivers ecense/State ID K Passpon K Alien Registration K Other Country 2t Cash in amount for individual or entity listed in Item 4 Account number Issuing State I 00 22 Cash out amount for Individual or entity listed in Item 4 $ 21.160 Account number[ 0 Page 2 of 5 SDNY_GM_00049858 CONFIDENTIAL - PURSUANT TO FED. R.CON(F IDENTIAL DB-SONY-00 12682 EFTA_00160466 EFTA01291932 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 '2 a O Person conducting Person conducting transaction on own behalf b law transaction for another 3 O Multiple transactions Person on whose behalf c O transaction was conducted d K Courier Service (Private) Check K 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 Beller Harry Male 9 Occupation or type of business 9a NAICS Code '10 Address O Unknown •11 City O Unknown •12 State O Unknown '14 Country O Unknown '15 TIN 0 Unknown '17 Date of birth 0 Unknown 18 Contact phone number 19 E-mail address Accountant 6412 12 Golar Dr Monsey '13 ZIP/Postal 16 TIN type Ext. Code 0 Unknown NY 10952 I. 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 NY 22 Cash out amount for irxhvidual or entity listed in Item 4 21.150 Account number a 0 0 Page 3 of 5 SDNY_GM_00049859 CONFIDENTIAL - PURSUANT TO FED. R.CON(F IDENTIAL DB-SONY-00 12683 EFTA_00I60467 EFTA01291933 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 12J19!2013 24 K Armored car (FI Contract) K ATM K Mail Deposit or Shipment K Night Deposit K Aggregated transactions •25 CASH IN: (in U.S. dollar equivalent) '27 CASH OUT: (In U.S. dollar equivalent) a Deposit(s) a Inathdrawal(s) b Payrnant(s) .00 b Advance(s) c Currency on aedit (Including markers) .00 c Currency received for funds transfor(s) out .00 pad horn funds trander(s) In .00 d Purchase of negotiable instrument (a) .00 d Negotiable instrumen(s) cashed .00 e Currency oxchange(s) 00 e Currency exchange(s) 21,160.00 I Currency to prepaid access .00 f Currency from prepaid access .00 g Purchases of casinos chips, tokens a Redemphon(s) of casino chips. tokens. and other gaming instruments 00 TITO tickets end other gaining Instruments 00 h Currency wager(s) ecluding h Pa/mantis) on wagerts) (Including race money pay's .00 and OTB or spans pool) .00 I Travel and complimentary expenses and I Bills inserted irnogarniag devices .00 book gaming Incentives .00 I Payment for tournament, contest or other t Other (specify): promotions .00 .00 z Other (specify) .00 Total Cash in .00 Total Cash out 21,16000 26 Foreign Cash in Foreign Country 0 0 28 Foreign Cash out 16,100 Foreign Country 0 0 BE Page 4 of 5 SDNY_GM_00049860 CONFIDENTIAL - PURSUANT TO FED. R.CON(F IDENTIAL DB-SONY-00 12684 EFTA_00I 60468 EFTA01291934 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 Other (specify) '29 Primary federal regulator Depository institution Federal Reserve Board (FRB) 38 If 37a - Casino/Card Club is checked, indicate type (chedc only one) K State licensed casino K Tribal authorized casino 0 Card club K Other '30 Legal name of financial institution Deutsche Bank Trust Company Americas 31 Alternate name, e.g. trade name, DBA '32 EIN '33 Address '34 City '35 Slate 346 Park Ave New York NY '36 ZIP Code j10154 39 Financial institution 10 type ID number '40 Contact office '41 Phone number '42 Date Filed DB PB AML Ext. (Dale filed will be auto -populated when des form is signed.) Page 5 of 5 SDNY_GM_00049861 CONFIDENTIAL - PURSUANT TO FED. R.CON(F IDENTIAL DB-SONY-0012685 EFTA_00160469 EFTA01291935