Form 8300 - Report Of Cash Payments Over 10,000 Received In A Trade Or Business
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58300
8300
Report of Cash Payments Over $10,000
IRS
FinCEN
Form
Received in a Trade or Business
Form
(Rev. July 2012)
(Rev. July 2012)
See instructions for definition of cash.
▶
OMB No. 1506-0018
OMB No. 1545-0892
Use this form for transactions occurring after July 8, 2012. 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
8 Date of birth .
7
.
.
Address (number, street, and apt. or suite no.)
M
M
D
D
Y
Y
Y
Y
▶
(see instructions)
9
City
10 State
11 ZIP code
12 Country (if not U.S.)
13 Occupation, profession, or business
14
Identifying
b Issued by
a Describe ID
▶
▶
document (ID)
c Number
▶
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
20
Doing business as (DBA) name (see instructions)
Employer identification number
21
Address (number, street, and apt. or suite no.)
22 Occupation, profession, or business
23
24 State
25 ZIP code
26 Country (if not U.S.)
City
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
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.
.
▶
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
Cashier’s check(s)
.00
Issuer’s name(s) and serial number(s) of the monetary instrument(s)
▶
$
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.
▶
c
Personal services provided
h
Escrow or trust funds
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
36 Employer identification number
35
Name of business that received cash
37
Address (number, street, and apt. or suite no.)
Social security number
38
39 State
40 ZIP code
41 Nature of your business
City
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
8300
8300
IRS Form
(Rev. 7-2012)
FinCEN Form
(Rev. 7-2012)
Cat. No. 62133S
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