rom 8300

(Rev, January 1989)

Department of the Treasury
Internal Revenue Service

Report of Cash Payments Over $10,000
Received in a Trade or Business

> Please type or print.

OMB No. 1545-0892
Expires: 12-31-89

Check here if
amended report >

im

Identity of Individual From Whom the Cash Was Received

TLast name

2 First name

3M.

4 Birth date
mo. da. yt.

5 Social security number

6 Number and street

7 Passport number 8 Country

9 Alien registration number

10 Country

11 City 12. State |13 ZIP code 14 Country (if not U.S.) |15 Business or Occupation | 16 Other identifying data (specify)

Type Number
iad Individual or Organization for Whom This Transaction Was Conducted
17 individual's last name 18 First name 19M. [20 Birthdate | 23 Social security number

mo., da. yr : :

22 Name of organization 23 Employer identification number 24 Passport number 25 Country
26 Number and street 27 Business or occupation 28 Alien registration number| 29 Country
30 City Bi State 32 ZiP code [33 Country (ifnot U.S.)| 34 Other identifying data (specify)

Type

| Number

Description of Transaction and Method of Payment

35 Amount of cash received .

u$

36 Amount in item 35 in $100 bills or higher. . $

37 Nature of transaction: [] Check here if part of multiple

or installment sale.

aD personal property purchased .

b Oo real property purchased

debt obligation paid
exchange of cash

escrow or trust funds

i C1 other (specity) >

personal services provided
business services provided

intangible property purchased

Specific description of property or service (Serial or registration no., address, etc.)

38 Method of Payment by Customer:
a LI Paid with U.S. currency or coin

b C1 Paid with foreign currency (describe)

39 Date paid
mo. da. yr.

Business Reporting This Transaction

40 Name of reporting business

41 Identification number

EIN H

42 Street address

SSN

43 City

44 State 45 ZIP code

‘46 Nature of your business

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

Sign
Here”

(Authorized Signature—See Instructions)

Title)

(Date)

For Paperwork Reduction Act Notice, see page 2.

Form 8300 (Rev. 1-89)


Form 8300 (Rev. 1-89)

Page 2

General Instructions

Paperwork Reduction Act Notice.— We ask
for this information to carry out the laws of the
United States. We need it to ensure that
persons are complying with these laws. You
are required to give us this information.

The time needed to complete and file this
form will vary depending on individual
circumstances. The estimated average time is
16 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 either 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. Also, a transaction is related even
though it occurs during a period of more than
24 hours if the recipient knows, or has reason
to know, that each transaction is one of a
series of connected transactions.

Multiple Payments.—How and when you
must report receipt of cash deposits, cash
installment payments, or other similar
payments or prepayments depends upon the
dollar amounts of the initial and subsequent
payments.

If the initial payment exceeds $10,000 and
any subsequent payment exceeds $10,000,
each payment that exceeds $10,000 must be
reported separately. (If the payments are
received less than 15 days apart, the recipient
may elect to make a single report of the
payments. The return is due within 15 days of
receipt of the initial payment.)

If the initial payment exceeds $10,000 but
no subsequent payment exceeds $10,000, the
recipient must report the initial payment
within 15 days. The subsequent payments
need not be reported.

If the initial payment does not exceed
$10,000, the recipient must add together the
initial payment and subsequent payments.
made within one year until the total exceeds
$10,000. Any subsequent payment that itself
exceeds $10,000 must be separately
reported.

Exceptions.—Section 1.6050I-1 of the
Regulations provides for a number of exceptions
to the reporting requirements. They include:
(1) Financial institutions required to file Form
4789, Currency Transaction Report, for a
cash transaction do not have to file Form
8300 for the same transaction.

Casinos required to file Form 8362,
Currency Transaction Report by Casinos,
are exempted from filing Form 8300 for
the same transaction. However,
nongaming businesses (such as shops,
restaurants, entertainment, and hotels)
at casino hotels and resorts must report
on Form 8300 receipt of cash in excess of
$10,000.

Receipt of currency in excess of $10,000
by a person other than in the person's
trade or business is not reportable.

Cash transactions that occur entirely
outside the United States are generally

(2)

@)

(4)

exempt from the reporting
requirements. The United States
includes the 50 states and the District
of Columbia. However, if any part of
the transaction occurs in Puerto Rico,
or a possession or territory of the
United States, and the recipient is
subject to the general jurisdiction of
the IRS under the Internal Revenue
Code, the transaction must be reported
by the recipient.

An agent who (a) receives cash froma
principal, (b) uses all of the cash

within 15 days ina cash transaction
that is reportable on Form 8300 or
4789, and (c) discloses the name,
address, and taxpayer identification
number of the principal to the

recipient of the cash in the second
transaction does not have to file Form
8300 for the initial receipt of the cash.
When and Where To File.—File this form by
the 15th day after the date of the transaction
with the Internal Revenue Service Detroit
Computing Center, P.O. Box 32621, Detroit,
MI 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-
USS. individuals, use the passport number or
alien registration number and indicate the
country.

Penalties.—Civil and criminal penalties
including up to 5 years imprisonment are
provided for failure to file a report or to supply
information, and for filing or causing the filing
of 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 reportable
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 I.—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. Use the 2-letter postal state
abbreviation in items 12, 31, and 44.

In box 5, enter the social security number of
the individual conducting the transaction. If
the individual has no number, write “None.”

If 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 box 16 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).

{(s)

Part Il.—If the individual in Part | is
conducting the transaction for himself or
herself only, 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 box 21, enter the social security number
of the individual for whom the transaction was
completed. If the individual has no number,
write “None.”

If 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 box 34 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 box 36 the amount of U.S.
currency included in box 35 that is in $100 bills
or higher. (For example, if the amount is
$30,000 and $25,000 of it was paid in $100
bills, enter $25,000 in box 36.)

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 box 39 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

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 notes and Federal
Reserve notes, but does not include bank
checks or drafts, travelers checks, wire
transfers, or other negotiable or monetary
instruments not customarily accepted as
money.

Transaction in Cash.—A transaction involving
the physical receipt of cash from a 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.—it includes (but is not limited
to) 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 toa
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.

U.S, Government Printing Office: 1989-242-473/80053