Report of Cash Payments Over $10,000 Received in a Trade or Business by mm6889


Form           8300
(Rev. November 2011)
                                                         Report of Cash Payments Over $10,000
                                                            Received in a Trade or Business
                                                                                                                                                                 Form      8300
                                                                                                                                                                 (Rev. November 2011)
                                                                       ▶ See instructions for definition of cash.
OMB No. 1545-0892                    ▶ Use
                                                                                                                                                                 OMB No. 1506-0018
                                               this form for transactions occurring after June 30, 2011. Do not use prior versions after this date.              Department of the Treasury
Department of the Treasury                                                                                                                                       Financial Crimes
Internal Revenue Service                               For Privacy Act and Paperwork Reduction Act Notice, see the last page.                                    Enforcement Network
   1       Check appropriate box(es) if:                         a      Amends prior report;                                  b       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 .                  .    .   .     .   .   .   . . .     .        . . . . . . . . .▶
   3       Last name                                                    4 First name                                              5 M.I.            6 Taxpayer identification number

   7       Address (number, street, and apt. or suite no.)                                                          8 Date of birth . .         .   ▶ 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               a Describe ID ▶                                                                                 b Issued by ▶
           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 .                           .     . . . . . . . . .▶
 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        City                                                        24 State      25 ZIP code           26 Country (if not U.S.)

 27        Alien               a Describe ID ▶                                                                                       b Issued by ▶
           identification (ID) c Number ▶
Part III           Description of Transaction and Method of Payment
 28        Date cash received                           29 Total cash received               30                                                     31 Total price if different from
                                                                                                   If cash was received in                             item 29
           M   M     D       D   Y     Y       Y   Y
                                                                                                   more than one payment,
                                                            $                         .00          check here . . . ▶                                   $                            .00
 32        Amount of cash received (in U.S. dollar equivalent) (must equal item 29) (see instructions):
      a    U.S. currency        $                 .00      (Amount in $100 bills or higher $                                        .00 )
      b    Foreign currency     $                 .00      (Country ▶                               )

      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          Personal property purchased                        f      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          Business services provided                     i      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

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

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

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


Signature                                                                                    Title
                                                          Authorized official
 43 Date of              M       M     D       D   Y     Y Y Y 44 Type or print name of contact person                             45 Contact telephone number
IRS Form 8300 (Rev. 11-2011)                                                       Cat. No. 62133S                                                    FinCEN Form 8300 (Rev. 11-2011)
IRS Form 8300 (Rev. 11-2011)                                           Page   2                                      FinCEN Form 8300 (Rev. 11-2011)
                                                                Multiple Parties
                                     (Complete applicable parts below if box 2 or 15 on page 1 is checked)

 Part I       Continued—Complete if box 2 on page 1 is checked
  3    Last name                                                         4 First name                     5 M.I.          6 Taxpayer identification number

  7    Address (number, street, and apt. or suite no.)                                        8 Date of birth . .     .   ▶ 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             a Describe ID ▶                                                                b Issued by ▶
       document (ID)           c Number ▶

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

  7    Address (number, street, and apt. or suite no.)                                        8 Date of birth . .     .   ▶ 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             a Describe ID ▶                                                                b Issued by ▶
       document (ID)           c Number ▶

 Part II      Continued—Complete if box 15 on page 1 is checked
 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    City                                               24 State   25 ZIP code        26 Country (if not U.S.)

 27    Alien                 a Describe ID ▶                                                                  b Issued by ▶
       identification (ID)   c Number ▶

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

 27    Alien                 a Describe ID ▶                                                                  b Issued by ▶
       identification (ID)   c Number   ▶

Comments – Please use the lines provided below to comment on or clarify any information you entered on any line in Parts I, II, III, and IV

IRS Form 8300 (Rev. 11-2011)                                                                                               FinCEN Form 8300 (Rev. 11-2011)
IRS Form 8300 (Rev. 11-2011)                                   Page   3                              FinCEN Form 8300 (Rev. 11-2011)
Section references are to the Internal        requirement can be satisfied either by          Multiple payments. If you receive more
Revenue Code unless otherwise noted.          sending a single written statement with         than one cash payment for a single
                                              an aggregate amount listed or by                transaction or for related transactions,
What's New                                    furnishing a copy of each Form 8300             you must report the multiple payments
                                              relating to that payer. Payments made to        any time you receive a total amount that
Future Developments. The IRS has              satisfy separate bail requirements are          exceeds $10,000 within any 12-month
created a page on for                 not required to be aggregated. See              period. Submit the report within 15 days
information about Form 8300, at               Treasury Regulations section 1.6050I-2.         of the date you receive the payment that Information                                                             causes the total amount to exceed
about any future developments affecting          Casinos must file Form 8300 for
                                              nongaming activities (restaurants, shops,       $10,000. If more than one report is
Form 8300 such as legislation enacted                                                         required within 15 days, you may file a
after we release it will be posted on that    etc.).
                                                                                              combined report. File the combined
page.                                         Voluntary use of Form 8300. Form                report no later than the date the earliest
                                              8300 may be filed voluntarily for any           report, if filed separately, would have to
Important Reminders                           suspicious transaction (see Definitions,        be filed.
• Section 6050I (26 United States Code        later) for use by FinCEN and the IRS,
                                              even if the total amount does not               Taxpayer identification number (TIN).
(U.S.C.) 6050I) and 31 U.S.C. 5331                                                            You must furnish the correct TIN of the
require that certain information be           exceed $10,000.
                                                                                              person or persons from whom you
reported to the IRS and the Financial         Exceptions. Cash is not required to be          receive the cash and, if applicable, the
Crimes Enforcement Network (FinCEN).          reported if it is received:                     person or persons on whose behalf the
This information must be reported on          • By a financial institution required to file   transaction is being conducted. You may
IRS/FinCEN Form 8300.                         Form 104, Currency Transaction Report;          be subject to penalties for an incorrect
• Item 33, box i, is to be checked only by    • By a casino required to file (or exempt       or missing TIN.
clerks of the court; box d is to be           from filing) Form 103, Currency                    The TIN for an individual (including a
checked by bail bondsmen. See Item 33         Transaction Report by Casinos, if the           sole proprietorship) is the individual’s
under Part III, later.                        cash is received as part of its gaming          social security number (SSN). For certain
• The meaning of the word “currency”          business;                                       resident aliens who are not eligible to get
for purposes of 31 U.S.C. 5331 is the         • By an agent who receives the cash             an SSN and nonresident aliens who are
same as for the word “cash” (See Cash         from a principal, if the agent uses all of      required to file tax returns, it is an IRS
under Definitions, later).                    the cash within 15 days in a second             Individual Taxpayer Identification
                                              transaction that is reportable on Form          Number (ITIN). For other persons,
General Instructions                          8300 or on Form 104, and discloses all          including corporations, partnerships, and
                                              the information necessary to complete           estates, it is the employer identification
Who must file. Each person engaged in
                                              Part II of Form 8300 or Form 104 to the         number (EIN).
a trade or business who, in the course
of that trade or business, receives more      recipient of the cash in the second                If you have requested but are not able
than $10,000 in cash in one transaction       transaction;                                    to get a TIN for one or more of the
or in two or more related transactions,       • In a transaction occurring entirely           parties to a transaction within 15 days
must file Form 8300. Any transactions         outside the United States. See                  following the transaction, file the report
conducted between a payer (or its             Publication 1544, Reporting Cash                and attach a statement explaining why
agent) and the recipient in a 24-hour         Payments of Over $10,000 (Received in           the TIN is not included.
period are related transactions.              a Trade or Business), regarding                 Exception: You are not required to
Transactions are considered related           transactions occurring in Puerto Rico           provide the TIN of a person who is a
even if they occur over a period of more      and territories and possessions of the          nonresident alien individual or a foreign
than 24 hours if the recipient knows, or      United States; or                               organization if that person or foreign
has reason to know, that each                 • In a transaction that is not in the           organization:
transaction is one of a series of             course of a person’s trade or business.         • Does not have income effectively
connected transactions.                                                                       connected with the conduct of a U.S.
                                              When to file. File Form 8300 by the
   Keep a copy of each Form 8300 for 5        15th day after the date the cash was            trade or business;
years from the date you file it.              received. If that date falls on a Saturday,     • Does not have an office or place of
   Clerks of federal or state courts must     Sunday, or legal holiday, file the form on      business, or a fiscal or paying agent in
file Form 8300 if more than $10,000 in        the next business day.                          the United States;
cash is received as bail for an               Where to file. File the form with the           • Does not furnish a withholding
individual(s) charged with certain criminal   Internal Revenue Service, Detroit               certificate described in §1.1441-1(e)(2) or
offenses. For these purposes, a clerk         Computing Center, P.O. Box 32621,               (3) or §1.1441-5(c)(2)(iv) or (3)(iii) to the
includes the clerk’s office or any other      Detroit, Ml 48232.                              extent required under §1.1441-1(e)(4)(vii);
office, department, division, branch, or                                                      or
unit of the court that is authorized to       Statement to be provided. You must
receive bail. If a person receives bail on    give a written or electronic statement to       • Does not have to furnish a TIN on any
behalf of a clerk, the clerk is treated as    each person named on a required Form            return, statement, or other document as
receiving the bail. See Item 33 under         8300 on or before January 31 of the             required by the income tax regulations
Part III, later.                              year following the calendar year in which       under section 897 or 1445.
                                              the cash is received. The statement             Penalties. You may be subject to
   If multiple payments are made in cash      must show the name, telephone number,
to satisfy bail and the initial payment                                                       penalties if you fail to file a correct and
                                              and address of the information contact          complete Form 8300 on time and you
does not exceed $10,000, the initial          for the business, the aggregate amount
payment and subsequent payments                                                               cannot show that the failure was due to
                                              of reportable cash received, and that the       reasonable cause. You may also be
must be aggregated and the information        information was furnished to the IRS.
return must be filed by the 15th day after                                                    subject to penalties if you fail to furnish
                                              Keep a copy of the statement for your           timely a correct and complete statement
receipt of the payment that causes the        records.
aggregate amount to exceed $10,000 in                                                         to each person named in a required
cash. In such cases, the reporting
IRS Form 8300 (Rev. 11-2011)                                 Page   4                             FinCEN Form 8300 (Rev. 11-2011)
report. A minimum penalty of $25,000            Exceptions. A cashier’s check, money       Item 8. Enter eight numerals for the date
may be imposed if the failure is due to      order, bank draft, or traveler’s check is     of birth of the individual named. For
an intentional or willful disregard of the   not considered received in a designated       example, if the individual’s birth date is
cash reporting requirements.                 reporting transaction if it constitutes the   July 6, 1960, enter 07 06 1960.
   Penalties may also be imposed for         proceeds of a bank loan or if it is           Item 13. Fully describe the nature of the
causing, or attempting to cause, a trade     received as a payment on certain              occupation, profession, or business (for
or business to fail to file a required       promissory notes, installment sales           example, “plumber,” “attorney,” or
report; for causing, or attempting to        contracts, or down payment plans. See         “automobile dealer”). Do not use general
cause, a trade or business to file a         Publication 1544 for more information.        or nondescriptive terms such as
required report containing a material        Person. An individual, corporation,           “businessman” or “self-employed.”
omission or misstatement of fact; or for     partnership, trust, estate, association, or   Item 14. You must verify the name and
structuring, or attempting to structure,     company.                                      address of the named individual(s).
transactions to avoid the reporting          Recipient. The person receiving the           Verification must be made by
requirements. These violations may also      cash. Each branch or other unit of a          examination of a document normally
be subject to criminal prosecution which,    person’s trade or business is considered      accepted as a means of identification
upon conviction, may result in               a separate recipient unless the branch        when cashing checks (for example, a
imprisonment of up to 5 years or fines of    receiving the cash (or a central office       driver’s license, passport, alien
up to $250,000 for individuals and           linking the branches), knows or has           registration card, or other official
$500,000 for corporations or both.           reason to know the identity of payers         document). In item 14a, enter the type of
                                             making cash payments to other                 document examined. In item 14b,
Definitions                                  branches.                                     identify the issuer of the document. In
Cash. The term “cash” means the              Transaction. Includes the purchase of         item 14c, enter the document’s number.
following.                                   property or services, the payment of          For example, if the individual has a Utah
• U.S. and foreign coin and currency         debt, the exchange of cash for a              driver’s license, enter “driver’s license”
received in any transaction; or              negotiable instrument, and the receipt of     in item 14a, “Utah” in item 14b, and the
                                             cash to be held in escrow or trust. A         number appearing on the license in item
• A cashier’s check, money order, bank                                                     14c.
draft, or traveler’s check having a face     single transaction may not be broken
amount of $10,000 or less that is            into multiple transactions to avoid           Note. You must complete all three items
received in a designated reporting           reporting.                                    (a, b, and c) in this line to make sure that
transaction (defined below), or that is      Suspicious transaction. A suspicious          Form 8300 will be processed correctly.
received in any transaction in which the     transaction is a transaction in which it
recipient knows that the instrument is       appears that a person is attempting to        Part II
being used in an attempt to avoid the        cause Form 8300 not to be filed, or to        Item 15. If the transaction is being
reporting of the transaction under either    file a false or incomplete form.              conducted on behalf of more than one
section 6050I or 31 U.S.C. 5331.                                                           person (including husband and wife or
Note. Cash does not include a check          Specific Instructions                         parent and child), check the box and
drawn on the payer’s own account, such                                                     complete Part II for any one of the
                                             You must complete all parts. However,         persons. Provide the same information
as a personal check, regardless of the       you may skip Part II if the individual
amount.                                                                                    for the other person(s) on the back of
                                             named in Part I is conducting the             the form. If more than three persons are
Designated reporting transaction. A          transaction on his or her behalf only. For    involved, provide the same information
retail sale (or the receipt of funds by a    voluntary reporting of suspicious             on additional sheets of paper and attach
broker or other intermediary in              transactions, see Item 1 next.                them to this form.
connection with a retail sale) of a          Item 1. If you are amending a report,
consumer durable, a collectible, or a                                                      Items 16 through 19. If the person on
                                             check box 1a. Complete the form in its        whose behalf the transaction is being
travel or entertainment activity.            entirety (Parts I-IV) and include the         conducted is an individual, complete
   Retail sale. Any sale (whether or not     amended information. Do not attach a          items 16, 17, and 18. Enter his or her
the sale is for resale or for any other      copy of the original report.                  TIN in item 19. If the individual is a sole
purpose) made in the course of a trade          To voluntarily report a suspicious         proprietor and has an employer
or business if that trade or business        transaction (see Suspicious transaction       identification number (EIN), you must
principally consists of making sales to      above), check box 1b. You may also            enter both the SSN and EIN in item 19.
ultimate consumers.                          telephone your local IRS Criminal             If the person is an organization, put its
   Consumer durable. An item of tangible     Investigation Division or call the FinCEN     name as shown on required tax filings in
personal property of a type that, under      Financial Institution Hotline at              item 16 and its EIN in item 19.
ordinary usage, can reasonably be            1-866-556-3974.                               Item 20. If a sole proprietor or
expected to remain useful for at least 1                                                   organization named in items 16 through
year, and that has a sales price of more     Part I                                        18 is doing business under a name other
than $10,000.                                Item 2. If two or more individuals            than that entered in item 16 (for
   Collectible. Any work of art, rug,        conducted the transaction you are             example, a “trade” or “doing business
antique, metal, gem, stamp, coin, etc.       reporting, check the box and complete         as (DBA)” name), enter it here.
   Travel or entertainment activity. An      Part I for any one of the individuals.        Item 27. If the person is not required to
item of travel or entertainment that         Provide the same information for the          furnish a TIN, complete this item. See
pertains to a single trip or event if the    other individual(s) on the back of the        Taxpayer identification number (TIN),
combined sales price of the item and all     form. If more than three individuals are      earlier. Enter a description of the type of
other items relating to the same trip or     involved, provide the same information        official document issued to that person
event that are sold in the same              on additional sheets of paper and attach      in item 27a (for example, a “passport”),
transaction (or related transactions)        them to this form.                            the country that issued the document in
exceeds $10,000.                             Item 6. Enter the taxpayer identification     item 27b, and the document’s number in
                                             number (TIN) of the individual named.         item 27c.
                                             See Taxpayer identification number (TIN),
                                             earlier, for more information.
IRS Form 8300 (Rev. 11-2011)                                    Page   5                             FinCEN Form 8300 (Rev. 11-2011)
Note. You must complete all three items        Item 41. Fully describe the nature of             Generally, tax returns and return
(a, b, and c) in this line to make sure that   your business, for example, “attorney” or      information are confidential, as stated in
Form 8300 will be processed correctly.         “jewelry dealer.” Do not use general or        section 6103. However, section 6103
                                               nondescriptive terms such as “business”        allows or requires the IRS to disclose or
Part III                                       or “store.”                                    give the information requested on this
Item 28. Enter the date you received the       Item 42. This form must be signed by an        form to others as described in the
cash. If you received the cash in more         individual who has been authorized to          Internal Revenue Code. For example, we
than one payment, enter the date you           do so for the business that received the       may disclose your tax information to the
received the payment that caused the           cash.                                          Department of Justice, to enforce the tax
combined amount to exceed $10,000.                                                            laws, both civil and criminal, and to
See Multiple payments, earlier, for more       Comments                                       cities, states, the District of Columbia,
information.                                   Use this section to comment on or              and U.S. commonwealths and
                                               clarify anything you may have entered          possessions, to carry out their tax laws.
Item 30. Check this box if the amount                                                         We may disclose this information to
shown in item 29 was received in more          on any line in Parts I, II, III, and IV. For
                                               example, if you checked box b                  other persons as necessary to obtain
than one payment (for example, as                                                             information which we cannot get in any
installment payments or payments on            (Suspicious transaction) in line 1 above
                                               Part I, you may want to explain why you        other way. We may disclose this
related transactions).                                                                        information to federal, state, and local
                                               think that the cash transaction you are
Item 31. Enter the total price of the          reporting on Form 8300 may be                  child support agencies; and to other
property, services, amount of cash             suspicious.                                    federal agencies for the purposes of
exchanged, etc. (for example, the total                                                       determining entitlement for benefits or
cost of a vehicle purchased, cost of                                                          the eligibility for and the repayment of
catering service, exchange of currency) if     Privacy Act and Paperwork Reduction            loans. We may also provide the records
different from the amount shown in item        Act Notice. Except as otherwise noted,         to appropriate state, local, and foreign
29.                                            the information solicited on this form is      criminal law enforcement and regulatory
Item 32. Enter the dollar amount of each       required by the IRS and FinCEN in order        personnel in the performance of their
form of cash received. Show foreign            to carry out the laws and regulations of       official duties. We may also disclose this
currency amounts in U.S. dollar                the United States Department of the            information to other countries under a
equivalent at a fair market rate of            Treasury. Trades or businesses, except         tax treaty, or to federal and state
exchange available to the public. The          for clerks of criminal courts, are required    agencies to enforce federal nontax
sum of the amounts must equal item 29.         to provide the information to the IRS and      criminal laws and to combat terrorism. In
For cashier’s check, money order, bank         FinCEN under both section 6050I and 31         addition, FinCEN may provide the
draft, or traveler’s check, provide the        U.S.C. 5331. Clerks of criminal courts         information to those officials if they are
name of the issuer and the serial number       are required to provide the information        conducting intelligence or
of each instrument. Names of all issuers       to the IRS under section 6050I. Section        counter-intelligence activities to protect
and all serial numbers involved must be        6109 and 31 U.S.C. 5331 require that           against international terrorism.
provided. If necessary, provide this           you provide your social security number           You are not required to provide the
information on additional sheets of paper      in order to adequately identify you and        information requested on a form that is
and attach them to this form.                  process your return and other papers.          subject to the Paperwork Reduction Act
                                               The principal purpose for collecting the       unless the form displays a valid OMB
Item 33. Check the appropriate box(es)         information on this form is to maintain
that describe the transaction. If the                                                         control number. Books or records
                                               reports or records which have a high           relating to a form or its instructions must
transaction is not specified in boxes a–i,     degree of usefulness in criminal, tax, or
check box j and briefly describe the                                                          be retained as long as their contents
                                               regulatory investigations or proceedings,      may become material in the
transaction (for example, “car lease,”         or in the conduct of intelligence or
“boat lease,” “house lease,” or “aircraft                                                     administration of any law under 26
                                               counterintelligence activities, by             U.S.C. or 31 U.S.C.
rental”). If the transaction relates to the    directing the federal government’s
receipt of bail by a court clerk, check        attention to unusual or questionable              The time needed to complete this
box i, “Bail received by court clerks.”        transactions.                                  form will vary depending on individual
This box is only for use by court clerks.                                                     circumstances. The estimated average
If the transaction relates to cash                You are not required to provide             time is 21 minutes. If you have
received by a bail bondsman, check box         information as to whether the reported         comments concerning the accuracy of
d, “Business services provided.”               transaction is deemed suspicious.              this time estimate or suggestions for
                                               Failure to provide all other requested         making this form simpler, you can write
Part IV                                        information, or providing fraudulent           to the Internal Revenue Service, Tax
                                               information, may result in criminal            Products Coordinating Committee,
Item 36. If you are a sole proprietorship,     prosecution and other penalties under
you must enter your SSN. If your                                                              SE:W:CAR:MP:T:M:S, 1111 Constitution
                                               26 U.S.C. and 31 U.S.C.                        Ave. NW, IR-6526, Washington, DC
business also has an EIN, you must
provide the EIN as well. All other                                                            20224. Do not send Form 8300 to this
business entities must enter an EIN.                                                          address. Instead, see Where to file,

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