Form 8300 - Fincen
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1
28300
8300
Report of Cash Payments Over $10,000
IRS
FinCEN
Form
Received in a Trade or Business
Form
(Rev. August 2014)
(Rev. August 2014)
See instructions for definition of cash.
▶
OMB No. 1506-0018
Use this form for transactions occurring after August 29, 2014. Do not use prior versions after this date.
▶
Department of the Treasury
Department of the Treasury
Financial Crimes
For Privacy Act and Paperwork Reduction Act Notice, see the last page.
Internal Revenue Service
Enforcement Network
1
Check appropriate box(es) if:
a
b
Amends prior report;
Suspicious transaction.
Part I
Identity of Individual From Whom the Cash Was Received
2
If more than one individual is involved, check here and see instructions .
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3
Last name
4 First name
5 M.I.
6 Taxpayer identification number
Last Name of Purchaser Representative
First Name of Purchaser Rep
1
2
3
4
5
6
7
8
9
8 Date of birth .
7
.
.
Address (number, street, and apt. or suite no.)
M
M
D
D
Y
Y
Y
Y
▶
(see instructions)
Address of Purchaser Representative
0
1
0
1
1
9
8
0
9
City
10 State
11 ZIP code
12 Country (if not U.S.)
13 Occupation, profession, or business
Miami
F
L
33131
14
Identifying
b Issued by
a Describe ID
Driver's License
Florida
▶
▶
document (ID)
c Number
1234567
▶
Part II
Person on Whose Behalf This Transaction Was Conducted
15
If this transaction was conducted on behalf of more than one person, check here and see instructions .
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▶
16
Individual’s last name or organization’s name
17 First name
18 M.I.
19 Taxpayer identification number
Name of Purchaser (i.e., name of LLC or Corporation)
20
Doing business as (DBA) name (see instructions)
Employer identification number
9
8
7
6
5
4
3
2
1
21
Address (number, street, and apt. or suite no.)
22 Occupation, profession, or business
Address of Purchaser (i.e., address of LLC or Corporation)
23
24 State
25 ZIP code
26 Country (if not U.S.)
City
Miami
F
L
33131
b Issued by
27
Alien
a Describe ID
▶
▶
identification (ID)
c Number
▶
Part III
Description of Transaction and Method of Payment
28
29 Total cash received
30
31 Total price if different from
Date cash received
If cash was received in
item 29
M
M
D
D
Y
Y
Y
Y
more than one payment,
$
.00
$
.00
check here
.
.
.
0
8
2
9
2
0
1
6
Currency/Check Amt
▶
1,200,000
32
Amount of cash received (in U.S. dollar equivalent) (must equal item 29) (see instructions):
$
(Amount in $100 bills or higher $
.00 )
a
U.S. currency
.00
$
)
(Country
b
Foreign currency
.00
▶
}
$
c
Check Amt
Cashier’s check(s)
.00
Issuer’s name(s) and serial number(s) of the monetary instrument(s)
▶
$
Issuer's name and serial number
d
Money order(s)
.00
$
e
Bank draft(s)
.00
f
Traveler’s check(s)
$
.00
33
Type of transaction
34 Specific description of property or service shown in
a
f
Personal property purchased
Debt obligations paid
33. Give serial or registration number, address, docket
b
Real property purchased
g
Exchange of cash
number, etc.
▶
Address of real property involved
c
Personal services provided
h
Escrow or trust funds
in Covered Transaction
d
i
Business services provided
Bail received by court clerks
e
Intangible property purchased
j
Other (specify in item 34)
▶
Part IV
Business That Received Cash
35
Name of business that received cash
36 Employer identification number
Name of Covered Business
5
4
3
2
1
6
7
8
9
37
Address (number, street, and apt. or suite no.)
Social security number
Address of Covered Business
38
39 State
40 ZIP code
41 Nature of your business
City
Miami
F
L
33131
Title Insurance
Under penalties of perjury, I declare that to the best of my knowledge the information I have furnished above is true, correct,
42
and complete.
Signature
Title
Authorized official
44 Type or print name of contact person
45 Contact telephone number
M
M
D
D
Y
Y
Y
Y
43 Date of
signature
Representative of Covered Business
Phone Number of Covered Business
8300
8300
IRS Form
(Rev. 8-2014)
FinCEN Form
(Rev. 8-2014)
Cat. No. 62133S
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