EFTA Document EFTA01291936

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 162.6248 Version Number 1.1 9 Type of filing Minitel report K Correct ia mend prior report K FinCEN directed Backfiling Document Control Number / BSA Identifier 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_00049862 CONFIDENTIAL — PURSUANT TO FED. R.CON(F IDENTIAL DB-SONY-0012686 EFTA_00I 60470 EFTA01291936 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 '2 a n Person conducting Flo Person conducting r—. Person on whose behalf - - transaction on own behalf b law transaction for another c 1—, transaction was conducted d O c4urier Service (private) 3 O Multiple transactions Check K If entity '4 Indwiduabe last name O Unknown or entitys legal name •5 First name O Unknown 6 Middle name Suffix 7 Gender 8 Alternate Name 9 Occupation or type of business 9a NAICS Code '10 Address O Unknown '11 City O Unknowil •12 State ❑Unknown [ •14 Country 0 Unknown Seller Harry Male Accountant •15 TIN 0 Unknown •17 Date of birth 0 Unknowl 18 Contact phone number 19 E-mail address '20 Form of identification used to verify identity US '13 ZIP/Postal Code 0 Unknown 16 TIN type Ext. SSN4TIN • Number OUnknown ig Drivers koensetState ID K Passport O Alien Registration O Other 628678340 Country US 21 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 $ 60.776 Account number) 1 0 • Page 2 of 5 SDNY_GM_00049863 CONFIDENTIAL - PURSUANT TO FED. R.QPN(F IDENTIAL DB-SONY-00 12687 EFTA_0016O47 I EFTA01291937 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 2 of 2 00 '2 a rn Person conducting r—r Person conducting — Person on whose behalf d K I—I transaction on own behalf b 1- 1 transaction for another c '16 transaction was conducted Cslal"r Service (rx"ed 3 O Multiple transactions Check O If entity '4 Individuars last name or entity's legal name •5 First name 6 Middle name Suffix 7 Gender 8 Alternate Name O Unknown O Unknown 9 Occupation or type of business Epstein Jeffrey Male 9a NAICS Code '10 Address O Unknown 6100 Red Hook Quarter 83 '11 City 0 Unknown I St. Thomas •12 State °unknown VI '13 ZIP/Postal Code 0 Unknown •14 Country O Unknown I. US 'IS TIN 0 Unknown l=11 18 TIN type SSICITIN •17 Date of birth 0 Unknown 0112011963 18 Contact phone number 19 Email address '20 Form of identification used to verify identity Number NUnknown O Drivers scene/Stale ID O Passport O Alien Registration Ei Other Country 00802 21 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 $ 60.776 Account number [ I 0 0 Page 3 of 5 SDNY_GM_00049864 CONFIDENTIAL - PURSUANT TO FED. R.QPN(F IDENTIAL DB-SONY-00 12688 EFTA_00 160472 EFTA01291938 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 01/3112014 24 O 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) a Deposit(s) b Payment(s) c Currency received for funds tranalin(s) out d Purchase of negotiable instrument (s) e Cuirency exchanges) Currency to prepaid nouns g Purchases of casinos °hada, tokens and other gaming instruments h Currency vrager(s) including money plays Bills inserted into gaining devices z Other (specify): .00 .00 .00 00 .00 00 00 .00 .00 Total Cash in .00 26 Foreign Cash in 28 Foreign Cash out 15,000 '27 CASH OUT: (In U.S. dollar equivalent) a Withdrawal(s) b Advance(s) on credit Including markers) C Costing pad from funds tram/m(s)in d Negotiable instrument(s) cashed e Currency exchange(%) Currency from prepaid aeons a h Z Other (specify) 00 .00 .00 40,000,00 20,776.00 .00 Redemplion(s)o/ casks, chips. tokens, TITO tickets and other gaming instruments Payments) on wasegs) (including nice and OTB or sports noon Travel and complimentary expenses and Cook gaming Incentives Payment for tournament. contest or other promotions Total Cash out Foreign Country Foreign Country $ 00 .00 .00 .00 .00 60.775.00 BE 0 0 0 0 Page 4 of S SDNY_GM_00049865 CONFIDENTIAL - PURSUANT TO FED. R.cON(E IDENTIAL DB-SONY-00 12689 EFTA_00 160473 EFTA01291939 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 17 Type of financial institution Other (specify) 19 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 0 Tribal authorized casino K Card dub K Other '30 Legal name of financial institution Deutsche Bank Trust Company Americas 31 Alternate name, e.g. trade name. OSA '32 EIN '33 Address '34 City 15 State ! 134941247 346 Park Ave New York I ■ '36 ZIP Code j10154 39 Financial institution 10 type ID number '40 Contact ofrce '41 Phone number '42 Date Filed DB PB AML Ext. (Dale filed will be auto -populated when Ihe form is signed.) Page 5 of 5 SDNY_GM_00049866 CONFIDENTIAL - PURSUANT TO FED. R.CON(F IDENTIAL DB-SONY-00 12690 EFTA_00160474 EFTA01291940