IRS Form 8300 (Rev. November 2011) Report of Cash Payments Over $10,000 Received in a Trade or Business FinCEN 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 signature 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 IRS.gov 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 www.irs.gov/form8300. 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, earlier.