rom 8300 Report of Cash Payments Over $10,000

OMB No. 1545-0892

(Rev. August 1988) Received in a Trade or Business Expires: 12-31-88
Department of the Treasury .
Internal Revenue Service > Please type or print.

Identity of Individual Conducting the Transaction
Last name First name MA. Social security number
Number and street Passport number Country Alien registration number | Country
City State ZIP code Country (if not U.S.)] Other identifying data (Specify)

Individual or Organization for Whom This Transaction Was Completed

Individuat's last name First name Ml. Social security number
Name of organization Employer identification number Passport number : Country
Number and street. Business or occupation Alien registration number | Country
City State ZIP code Country (if not U.S.) | Other identifying data (Specify)

J Part II | Description of Transaction and Method of Payment

1 Amount of cashreceived. . .$ 2 Amountinitem1in$100bills. . .$
3 Nature of transaction: Description of property or service

aQ personal property purchased .

b Oo real property purchased

cO personal servicesprovided . . . . ~~

a0 business servicesprovided . . . 2. ws ee

eO intangible property purchased . . . . . -

#01 debtobligationpaid . . 2... 2.1

el exchangeofcash . . . . . ss

nO escrowortrustfunds 2... ee ee

iO] other (specify) >
4 Method of payment by customer:
a Paidwithu.s. currency or coin
b CO Paid with foreign currency (describe) ..

“(5 Date paid

ixaahg Business Reporting This Transaction
‘Name of reporting business

Identification number (EIN or SSN)

Street address
Nature of your business

City State ZIP code

Under penalties of perjury, | declare that the information I have furnished above, to the best of my knowledge, is true, correct, and complete.

Sign
Here”

(Authorized Signature—See Instructions) Title) (Date)

For Paperwork Reduction Act Notice, see page 2. Form 8300 (Rev. 8-88)


Form 8300 (Rev. 8-88)

Page 2

General Instructions

Paperwork Reduction Act Notice.— We ask
for this information to carry out the Internal
Revenue laws of the United States. We need it
to ensure that taxpayers are complying with
these laws and to allow us to figure and collect
the right amount of tax. You are required to
give us this information.

The estimated average time needed to
complete this form, depending on individual
circumstances, is 15 minutes. If you have
comments concerning the accuracy of this.
time estimate or suggestions for making this
form more simple, we would be happy to hear
from you. You can write to the Internal
Revenue Service, Washington, DC 20224,
Attention: IRS Reports Clearance Officer
TR:FP; or the Office of Management and
Budget, Paperwork Reduction Project,
Washington, DC 20503.

Who Must File.—Each person engaged ina

trade or business who, in the course of such

trade or business, receives more than $10,000
in cash in one transaction, or two or more
related transactions, must file Form 8300. Any
transactions conducted between a payer (or its
agent) and the recipient in a 24-hour period are
related transactions, and must be aggregated
and reported as a single transaction if the total
amount exceeds $10,000. For other
transactions that may be related and special
filing requirements for installment payments,
see section 1.6050I-1 of the regulations.

Certain precious metals dealers, precious
stones dealers, jewelry dealers, pawnbrokers,
loan or finance companies, insurance
companies and travel agencies must file Form
8300 when they have reportable cash
transactions. To the extent that the Assistant
Secretary of the Treasury (Enforcement and
Operations) requires these financial
institutions to file Form 4789, Currency
Transaction Report, Form 8300 is not required
to be filed for the same transaction(s).
Exceptions. —Financial institutions required
to file IRS Form 4789 under Section
5312(a)(2)(A), (B), (C), (D), (E), (F), (G), W),
(K), (R), and (8) of Title 31, U.S.C., are
excepted from filing Form 8300. These
financial institutions include each agency,
branch, or office in the United States of any
person doing business in one or more of the
capacities listed below:

(1) a bank (see Definitions);

(2) a broker or dealer in securities, registered
or required to be registered with SEC under
the Securities Exchange Act of 1934;

(3) a person who engages as a business in
dealing in or exchanging currency (for
example, a dealer in foreign exchange or a
person engaged primarily in the cashing of
checks);

(4) a person who engages as a business
issuing, selling, or redeeming traveler's
checks, money orders, or similar
instruments, except one who does so as a
selling agent exclusively, or as an incidental
part of another business;

(5) a licensed transmitter of funds, or other
person engaged in the business of
transmitting funds abroad for others.

Transactions entirely occurring outside the
United States are excepted from these
reporting requirements, except as provided in
section 1.6050 |-1(d)(4) of the regulations.
The United States includes the 50 states and
the District of Columbia.

When and Where To File.—File this form by

the 15th day after the date of the transaction

with the Internal Revenue Service Data

Center, P.O. Box 32621, Detroit, Ml 48232

ATTN: RCP or hand carry it to your local IRS
office. Keep a copy of each Form 8300 for 5
years from the date you file it.

Identifying Number.—For individuals this is
the social security number. For others it is the
Federal employer identification number (EIN),
which has 9 digits. For aliens or other non-U.S.
individuals, use the passport number or alien
registration number and indicate the country.

Penalties. —Civil and criminal penalties are
provided for failure to file a report or to supply
information, and for filing a false or fraudulent
report.

Statement To Be Provided.—A written
statement must be provided to each person
named in this form. The statement must be
provided on or before January 31 of the year
following the calendar year in which this report
is made. The statement must show the name
and address of the business receiving the cash
and the total amount of cash received during
the year from the payer and that the
information is being furnished to the IRS. Keep
a copy for your records. A copy of the Form
8300 that was filed with the Internal Revenue
Service may be used as the statement if the
payer had a single transaction for the year.

Specific Instructions
Part!

This part must always be completed. If the
individual conducts the transaction for another
person, be sure to complete Part II also.

In the address section, enter the permanent
street address of the individual conducting the
transaction.

In the social security block, enter the social
security number of the individual conducting
the transaction. If the individual has no
number, write “None” in this block.

{f the individual is an alien or foreign
national, enter the alien registration number
or passport number and country or other
official documents evidencing nationality or
residence in the boxes provided.

Complete the “Other identifying data” box
for individuals other than aliens and foreign
nationals. Other identifying information
includes documents normally acceptable as a
means of identification when cashing checks
(e.g., a driver's license or credit card number
may be entered in the “Other identifying data”
box provided).

Part Il

If the individual in Part | is conducting tne
transaction for himself or herself, do not
complete Part Il. In all other cases, complete
Part Il.

For individuals, enter last name, first name,
middle initial, if any, and street address in the
boxes provided. For other than an individual,
enter the complete organization name,
address, and employer identification number
in the boxes provided.

In the social security block, enter the social
security number of the individual for whom the
transaction was completed. If the individual
has no number, write “Non this block.

{f the individual is an alien or foreign
national, enter the alien registration number or
passport number and country or other official
documents evidencing nationality or residence
in the boxes provided.

Complete the “Other identifying data” box
for individuals other than aliens and foreign
nationals. Other identifying information
includes documents normally acceptable as a
means of identification when cashing checks
(e.g., a driver's license or credit card number

may be entered in the “Other identifying data”
box provided).

Part Ill

Enter in item 2 the amount of U.S. currency
included in item 1 that is in $100 bills or
higher. (For example, if the amount in item 1 is
$30,000, and $25,000 of it was paid in $100
bills, enter $25,000 in item 2.)

Check the applicable boxes that describe
the nature of the transaction. Briefly describe
the kind of property or service for which the
customer paid cash.

If the aggregate amount of cash received in
two or more installment payments exceeds
$10,000, the date entered in item 5 should be
the date the payment is made that causes the
aggregate amount of cash to exceed $10,000.

Part IV

Signature.—This report must be signed by an
authorized individual. Also type or print the
name of the authorized signer below the
signature.

Definitions

Bank.—Each agent, agency, branch, or office

in the United States of a foreign bank and

each agency, branch, or office in the United

States of any person doing business in one or

more of the capacities listed below:

(1) a commercial bank or trust company
organized under the laws of any state or of
the United States;

(2) a private bank;

(3) a savings and loan association or a building

and loan association organized under the laws

of any state or of the United States;

(4) an insured institution as defined in section
401 of the National Housing Act;

(5) a savings bank, industrial bank, or other
thrift institution;

(6) a credit union organized under the
laws of any state or of the United
States; and

(7) any other organization chartered under the
banking laws of any state and subject to
the supervision of the bank supervisory
authorities of a state.

Person.—An individual, corporation,

partnership, trust or estate, joint stock

company, association, syndicate, joint
venture, or other unincorporated organization
or group, and all entities treated as legal
personalities, including organizations that are
exempt from tax.

Cash.—The coin and currency of the United

States or of any other country, which circulate

in and are customarily used and accepted as

money in the country in which issued. It
includes United States silver certificates,

United States notes, and Federal Reserve

notes, but does not include bank checks,

traveler's checks, or other negotiable or
monetary instruments not customarily
accepted as money.

Transaction in Cash.—A transaction

involving the physical receipt of cash froma

person. A transaction in cash does not include

a receipt of funds by means of bank check,

bank draft, wire transfer, or other written

order that does not include the physical
transfer of cash.

Transaction.—The purchase of goods,

services, personal or real property, and

intangible property by a customer; a debt
obligation paid for with cash; the receipt and
conversion of cash to a negotiable instrument

(for instance, a receipt of cash from a person

in exchange for a check); and the receipt of

cash to be held in escrow or trust.