Report of Cash Payments Over $10,000

Received in a Trade or Business Form 8300

OMB No. 1545-0892 (Rev. August 1997) © See instructions for definition of cash.

Department of the Treasury

Internal Revenue Service Please type or print.

1 Check appropriate box(es) if: a Amends prior report; b Suspicious transaction.

Identity of Individual From Whom the Cash Was Received

2 If more than one individual is involved, check here and see instructions ©

3 Last name 4 First name 5 M.I. 6 Taxpayer identification number

13 Occupation, profession, or business

7 Address (number, street, and apt. or suite no.) 8 Date of birth ©

9 City 10 State 11 ZIP code 12 Country (if not U.S.)

14 Document used to verify identity: a Describe identification ©

b Issued by c Number

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 ©

16 Individual’s last name or Organization’s name 17 First name 18 M.I. 19

27 Alien identification: a Describe identification ©

Employer identification number

b Issued by c Number

21 Address (number, street, and apt. or suite no.) 22 Occupation, profession, or business

23 City 24 State 25 ZIP code 26 Country (if not U.S.)

Description of Transaction and Method of Payment

d Business services provided

a Personal property purchased

e Intangible property purchased

b Real property purchased

c Personal services provided

32

28 Date cash received

$ .00

Business That Received Cash

35 Name of business that received cash 36 Employer identification number

37 Address (number, street, and apt. or suite no.) Social security number

38 City 39 State 40 ZIP code 41 Nature of your business

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

and complete.

42

Cat. No. 62133S Form 8300 (Rev. 8-97)

Part IV

Part I

Part II

Part III

U.S. currency

b Foreign currency

20 Doing business as (DBA) name (see instructions)

29 Total cash received

$ .00

If cash was received in

more than one payment,

check here ©

30 Total price if different from

item 29

31

$ .00

Amount of cash received (in U.S. dollar equivalent) (must equal item 29) (see instructions):

a

.00

.00

.00

.00

.00

c Cashier’s check(s)

d Money order(s)

e Bank draft(s)

f Traveler’s check(s)

(Amount in $100 bills or higher )

(Country © )

$ .00

33 Type of transaction

g Exchange of cash

h Escrow or trust funds

j Other (specify) ©

f Debt obligations paid Specific description of property or service shown in 33.

(Give serial or registration number, address, docket

number, etc.) ©

34

Issuer’s name(s) and serial number(s) of the monetary instrument(s) ©

%

(see instructions)

M YYYY M D D

MM Y Y Y Y D D

Taxpayer identification number

MM Y Y Y Y D D

i Bail bond

Signature of authorized official Title of authorized official

Date

of

signature

Type or print name of contact person Contact telephone number

( )

43 44 45

$

$

$

$

$

© Use this form for transactions occurring after July 31, 1997.

For Paperwork Reduction Act Notice, see page 4.
Continued—Complete if box 2 on page 1 is checked

Continued—Complete if box 15 on page 1 is checked

Part I

Part II

Form 8300 (Rev. 8-97) Page 2

Multiple Parties

(Complete applicable parts below if box 2 or 15 on page 1 is checked)

3 Last name 4 First name 5 M.I. 6 Taxpayer identification number

13 Occupation, profession, or business

7 Address (number, street, and apt. or suite no.) 8 Date of birth ©

9 City 10 State 11 ZIP code 12 Country (if not U.S.)

14 Document used to verify identity: a Describe identification ©

b Issued by c Number

(see instructions)

MM YYYY D D

3 Last name 4 First name 5 M.I. 6 Taxpayer identification number

13 Occupation, profession, or business

7 Address (number, street, and apt. or suite no.) 8 Date of birth ©

9 City 10 State 11 ZIP code 12 Country (if not U.S.)

14 Document used to verify identity: a Describe identification ©

b Issued by c Number

(see instructions)

MM Y Y Y Y D D

16 Individual’s last name or Organization’s name 17 First name 18 M.I. 19

27 Alien identification: a Describe identification ©

Employer identification number

b Issued by c Number

21 Address (number, street, and apt. or suite no.) 22 Occupation, profession, or business

23 City 24 State 25 ZIP code 26 Country (if not U.S.)

20 Doing business as (DBA) name (see instructions)

Taxpayer identification number

16 Individual’s last name or Organization’s name 17 First name 18 M.I. 19

27 Alien identification: a Describe identification ©

Employer identification number

b Issued by c Number

21 Address (number, street, and apt. or suite no.) 22 Occupation, profession, or business

23 City 24 State 25 ZIP code 26 Country (if not U.S.)

20 Doing business as (DBA) name (see instructions)

Taxpayer identification number
Form 8300 (Rev. 8-97) Page 3

Item You Should Note

Clerks of Federal or State courts must now

file Form 8300 if more than $10,000 in

cash is received as bail for an individual(s)

charged with certain criminal offenses. For

these purposes, a clerk includes the clerk’s

office or any other office, department,

division, branch, or unit of the court that is

authorized to receive bail. If a person

receives bail on behalf of a clerk, the clerk

is treated as receiving the bail.

General Instructions

Who must file.—Each person engaged in

a trade or business who, in the course of

that trade or business, receives more than

$10,000 in cash in one transaction or in

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. Transactions are considered

related even if they occur over 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.

Exceptions.—Cash is not required to be

reported if it is received:

When to file.—File Form 8300 by the 15th

day after the date the cash was received.

If that date falls on a Saturday, Sunday, or

legal holiday, file the form on the next

business day.

Statement to be provided.—You must

give a written statement to each person

named on a required Form 8300 on or

before January 31 of the year following the

calendar year in which the cash is

received. The statement must show the

name, telephone number, and address of

the information contact for the business,

the aggregate amount of reportable cash

received, and that the information was

furnished to the IRS. Keep a copy of the

statement for your records.

Multiple payments.—If you receive more

than one cash payment for a single

transaction or for related transactions, you

must report the multiple payments any

time you receive a total amount that

exceeds $10,000 within any 12-month

period. Submit the report within 15 days of

the date you receive the payment that

causes the total amount to exceed

$10,000. If more than one report is

required within 15 days, you may file a

combined report. File the combined report

no later than the date the earliest report, if

filed separately, would have to be filed.

Taxpayer identification number (TIN).—

You must furnish the correct TIN of the

person or persons from whom you receive

the cash and, if applicable, the person or

persons on whose behalf the transaction is

being conducted. You may be subject to

penalties for an incorrect or missing TIN.

Penalties.—You may be subject to

penalties if you fail to file a correct and

complete Form 8300 on time and you

cannot show that the failure was due to

reasonable cause. You may also be

subject to penalties if you fail to furnish

timely a correct and complete statement to

each person named in a required report. A

minimum penalty of $25,000 may be

imposed if the failure is due to an

intentional disregard of the cash reporting

requirements.

Definitions

Cash.—The term “cash” means the

following:

● U.S. and foreign coin and currency

received in any transaction.

● A cashier’s check, money order, bank

draft, or traveler’s check having a face

amount of $10,000 or less that is received

in a designated reporting transaction

(defined below), or that is received in any

transaction in which the recipient knows

that the instrument is being used in an

attempt to avoid the reporting of the

transaction under section 6050I.

Designated reporting transaction.—A

retail sale (or the receipt of funds by a

broker or other intermediary in connection

with a retail sale) of a consumer durable, a

collectible, or a travel or entertainment

activity.

Retail sale.—Any sale (whether or not the

sale is for resale or for any other purpose)

made in the course of a trade or business

if that trade or business principally consists

of making sales to ultimate consumers.

Consumer durable.—An item of tangible

personal property of a type that, under

ordinary usage, can reasonably be

expected to remain useful for at least 1

year, and that has a sales price of more

than $10,000.

Collectible.—Any work of art, rug,

antique, metal, gem, stamp, coin, etc.

Travel or entertainment activity.—An item

of travel or entertainment that pertains to a

single trip or event if the combined sales

price of the item and all other items

relating to the same trip or event that are

sold in the same transaction (or related

transactions) exceeds $10,000.

Exceptions.—A cashier’s check, money

order, bank draft, or traveler’s check is not

considered received in a designated

● By a financial institution required to file

Form 4789, Currency Transaction Report.

● By a casino required to file (or exempt

from filing) Form 8362, Currency

Transaction Report by Casinos, if the cash

is received as part of its gaming business.

● By an agent who receives the cash from

a principal, if the agent uses all of the cash

within 15 days in a second transaction that

is reportable on Form 8300 or on Form

4789, and discloses all the information

necessary to complete Part II of Form

8300 or Form 4789 to the recipient of the

cash in the second transaction.

● In a transaction occurring entirely

outside the United States. See Pub. 1544,

Reporting Cash Payments Over $10,000

(Received in a Trade or Business),

● In a transaction that is not in the course

of a person’s trade or business.

Note: Cash does not include a check

drawn on the payer’s own account, such as

a personal check, regardless of the amount.

If multiple payments are made in cash to

satisfy bail and the initial payment does

not exceed $10,000, the initial payment

and subsequent payments must be

aggregated and the information return

must be filed by the 15th day after receipt

of the payment that causes the aggregate

amount to exceed $10,000 in cash. In such

cases, the reporting requirement can be

satisfied either by sending a single written

statement with an aggregate amount listed

or by furnishing a copy of each Form 8300

relating to that payer. Payments made to

satisfy separate bail requirements are not

required to be aggregated. See Treasury

Regulations section 1.6050I-2.

Voluntary use of Form 8300.—Form 8300

may be filed voluntarily for any suspicious

transaction (see Definitions), even if the

total amount does not exceed $10,000.

If you have requested but are not able to

get a TIN for one or more of the parties to

a transaction within 15 days following the

transaction, file the report and attach a

statement explaining why the TIN is not

included.

Exception: You are not required to provide

the TIN of a person who is a nonresident

alien individual or a foreign organization if

that person does not have income

effectively connected with the conduct of a

U.S. trade or business and does not have

an office or place of business, or fiscal or

paying agent, in the United States. See

Pub. 1544 for more information.

Penalties may also be imposed for

causing, or attempting to cause, a trade or

business to fail to file a required report; for

causing, or attempting to cause, a trade or

business to file a required report containing

a material omission or misstatement of

fact; or for structuring, or attempting to

structure, transactions to avoid the

reporting requirements. These violations

may also be subject to criminal

prosecution which, upon conviction, may

result in imprisonment of up to 5 years or

fines of up to $250,000 for individuals and

$500,000 for corporations or both.

Keep a copy of each Form 8300 for 5

years from the date you file it.

Where to file.—File the form with the

Internal Revenue Service, Detroit

Computing Center, P.O. Box 32621,

Detroit, Ml 48232, or hand carry it to your

local IRS office.

The TIN for an individual (including a

sole proprietorship) is the individual’s

social security number (SSN). For certain

resident aliens who are not eligible to get

an SSN and nonresident aliens who are

required to file tax returns, it is an IRS

Individual Taxpayer Identification Number

(ITIN). For other persons, including

corporations, partnerships, and estates, it

is the employer identification number.

regarding transactions occurring in Puerto

Rico, the Virgin Islands, and territories and

possessions of the United States.

Casinos must file Form 8300 for

nongaming activities (restaurants, shops,

etc.).
Form 8300 (Rev. 8-97) Page 4

Part I

Item 2.—If two or more individuals

conducted the transaction you are

reporting, check the box and complete

Part I for any one of the individuals.

Provide the same information for the other

individual(s) on the back of the form. If

more than three individuals are involved,

provide the same information on additional

sheets of paper and attach them to this

form.

Item 6.—Enter the taxpayer identification

number (TIN) of the individual named. See

Taxpayer identification number (TIN)

under General Instructions for more

information.

Item 8.—Enter eight numerals for the date

of birth of the individual named. For

example, if the individual’s birth date is

July 6, 1960, enter 07 06 1960.

Item 13.—Fully describe the nature of the

occupation, profession, or business (for

example, “plumber,” “attorney,” or

“automobile dealer”). Do not use general or

Item 14.—You must verify the name and

address of the named individual(s).

Verification must be made by examination

of a document normally accepted as a

means of identification when cashing

checks (for example, a driver’s license,

passport, alien registration card, or other

official document). In item 14a, enter the

type of document examined. In item 14b,

identify the issuer of the document. In item

14c, enter the document’s number. For

example, if the individual has a Utah

driver’s license, enter “driver’s license” in

item 14a, “Utah” in item 14b, and the

number appearing on the license in item

14c.

Part II

Item 15.—If the transaction is being

conducted on behalf of more than one

person (including husband and wife or

parent and child), check the box and

complete Part II for any one of the

persons. Provide the same information for

the other person(s) on the back of the

form. If more than three persons are

involved, provide the same information on

additional sheets of paper and attach them

to this form.

Items 16 through 19.—If the person on

whose behalf the transaction is being

conducted is an individual, complete items

16, 17, and 18. Enter his or her TIN in item

19. If the individual is a sole proprietor and

has an employer identification number

(EIN), you must enter both the SSN and

EIN in item 19. If the person is an

organization, put its name as shown on

required tax filings in item 16 and its EIN in

item 19.

Item 20.—If a sole proprietor or

organization named in items 16 through 18

is doing business under a name other than

that entered in item 16 (e.g., a “trade” or

“doing business as (DBA)” name), enter it

here.

Item 27.—If the person is NOT required to

furnish a TIN (see Taxpayer identification

number (TIN) under General

Instructions), complete this item. Enter a

description of the type of official document

issued to that person in item 27a (for

example, “passport”), the country that

issued the document in item 27b, and the

document’s number in item 27c.

Part III

Item 28.—Enter the date you received the

cash. If you received the cash in more than

one payment, enter the date you received

the payment that caused the combined

amount to exceed $10,000. See Multiple

payments under General Instructions for

more information.

Item 30.—Check this box if the amount

shown in item 29 was received in more

than one payment (for example, as

installment payments or payments on

related transactions).

Item 31.—Enter the total price of the

property, services, amount of cash

exchanged, etc. (for example, the total cost

Item 32.—Enter the dollar amount of each

form of cash received. Show foreign

currency amounts in U.S. dollar equivalent

at a fair market rate of exchange available

to the public. The sum of the amounts

must equal item 29. For cashier’s check,

money order, bank draft, or traveler’s

check, provide the name of the issuer and

the serial number of each instrument.

Names of all issuers and all serial numbers

involved must be provided. If necessary,

provide this information on additional

sheets of paper and attach them to this

form.

Item 33.—Check the appropriate box(es)

that describe the transaction. If the

transaction is not specified in boxes a–i,

check box j and briefly describe the

transaction (for example, car lease, boat

lease, house lease, aircraft rental).

Part IV

Item 36.—If you are a sole proprietorship,

you must enter your SSN. If your business

also has an EIN, you must provide the EIN

as well. All other business entities must

enter an EIN.

Item 41.—Fully describe the nature of your

business, for example, “attorney,” “jewelry

dealer.” Do not use general or

nondescriptive terms such as “business” or

“store.”

Paperwork Reduction Act

Notice

The requested information is useful in

criminal, tax, and regulatory investigations,

for instance, by directing the Federal

Government’s attention to unusual or

questionable transactions. Trades or

businesses are required to provide the

information under 26 U.S.C. 6050I.

The time needed to complete this form

will vary depending on individual

circumstances. The estimated average time

is 21 minutes. If you have comments

concerning the accuracy of this time

estimate or suggestions for making this

form simpler, you can write to the Tax

Forms Committee, Western Area

Distribution Center, Rancho Cordova, CA

95743-0001. DO NOT send this form to

this office. Instead, see Where To File on

page 3.

Transaction.—Includes the purchase of

property or services, the payment of debt,

the exchange of a negotiable instrument

for cash, and the receipt of cash to be

held in escrow or trust. A single

transaction may not be broken into

multiple transactions to avoid reporting.

Suspicious transaction.—A transaction in

which it appears that a person is

attempting to cause Form 8300 not to be

filed, or to file a false or incomplete form.

The term also includes any transaction in

which there is an indication of possible

illegal activity.

Specific Instructions

You must complete all parts. However, you

may skip Part II if the individual named in

Part I is conducting the transaction on his

or her behalf only.

Item 1.—If you are amending a prior

report, check box 1a. Complete the

appropriate items with the correct or

amended information only. Complete all of

Part IV. Staple a copy of the original report

to the amended report.

To voluntarily report a suspicious

transaction (see Definitions), check box

1b. You may also telephone your local IRS

Criminal Investigation Division or call

1-800-800-2877.

You are not required to provide the

information requested on a form that is

subject to the Paperwork Reduction Act

unless the form displays a valid OMB

control number. Books or records relating

to a form or its instructions must be

retained as long as their contents may

become material in the administration of

any Internal Revenue law. Generally, tax

returns and return information are

confidential, as required by Code section

6103.

Person.—An individual, corporation,

partnership, trust, estate, association, or

company.

Recipient.—The person receiving the cash.

Each branch or other unit of a person’s

trade or business is considered a separate

recipient unless the branch receiving the

cash (or a central office linking the

branches), knows or has reason to know

the identity of payers making cash

payments to other branches.

Item 42.—This form must be signed by an

individual who has been authorized to do

so for the business that received the cash.

reporting transaction if it constitutes the

proceeds of a bank loan or if it is received

as a payment on certain promissory notes,

installment sales contracts, or down

payment plans. See Pub. 1544 for more

information.

nondescriptive terms such as

“businessman” or “self-employed.”

of a vehicle purchased, cost of catering

service, exchange of currency) if different

from the amount shown in item 29.