Text extracted via OCR from the original document. May contain errors from the scanning process.
Currency Transaction Report
OMB No. 1506-0064
Filing Name
162.6248
Version Number 1.1
9 Type of filing
Minitel report
K Correct ia mend prior report
K FinCEN directed Backfiling
Document Control Number / BSA Identifier
Save
Validate
Print
Under penalties of perjury. I declare that I have examined this transmittal, including accompanying
documents, and to the best of my knowledge and belief it is correct and complete. In the case of documents
without recipients identifying numbers, I have complied with the requirements of the law in attempting to
secure such numbers from the receipts. I declare that this filing represents all Documents filed during this
reporting period except for those transactions reported on paper.
Sign with PIN
SDNY_GM_00049862
CONFIDENTIAL — PURSUANT TO FED. R.CON(F IDENTIAL
DB-SONY-0012686
EFTA_00I 60470
EFTA01291936
---PAGE BREAK---
Part I Person Involved in Transaction 1
of 2
00
'2
a n
Person conducting
Flo Person conducting
r—. Person on whose behalf
- -
transaction on own behalf
b law transaction for another
c 1—, transaction was conducted
d O c4urier Service (private)
3
O Multiple transactions
Check
K If entity
'4 Indwiduabe last name O Unknown
or entitys legal name
•5 First name
O Unknown
6 Middle name
Suffix
7 Gender
8 Alternate Name
9 Occupation or type of business
9a NAICS Code
'10 Address
O Unknown
'11 City
O Unknowil
•12 State
❑Unknown [
•14 Country
0 Unknown
Seller
Harry
Male
Accountant
•15 TIN
0 Unknown
•17 Date of birth
0 Unknowl
18 Contact phone number
19 E-mail address
'20 Form of identification used to verify identity
US
'13 ZIP/Postal Code 0 Unknown
16 TIN type
Ext.
SSN4TIN
•
Number
OUnknown
ig Drivers koensetState ID K Passport
O Alien Registration O Other
628678340
Country
US
21 Cash in amount for individual or entity listed in Item 4
Account number
Issuing State •
I 00
22 Cash out amount for Individual or entity listed in Item 4
$
60.776
Account number)
1 0 •
Page 2 of 5
SDNY_GM_00049863
IDENTIAL
DB-SONY-00 12687
EFTA_0016O47 I
EFTA01291937
---PAGE BREAK---
Part I Person Involved in Transaction 2
of 2
00
'2
a rn Person conducting
r—r Person conducting
— Person on whose behalf
d K
I—I transaction on own behalf
b 1- 1 transaction for another
c '16 transaction was conducted
Cslal"r Service (rx"ed
3
O
Multiple transactions
Check
O If entity
'4 Individuars last name
or entity's legal name
•5 First name
6 Middle name
Suffix
7 Gender
8 Alternate Name
O Unknown
O Unknown
9 Occupation or type of business
Epstein
Jeffrey
Male
9a NAICS Code
'10 Address
O Unknown
6100 Red Hook Quarter 83
'11 City
0 Unknown I St. Thomas
•12 State
°unknown
VI
'13 ZIP/Postal Code 0 Unknown
•14 Country
O Unknown I.
US
'IS TIN
0
Unknown l=11
18 TIN type
SSICITIN
•17 Date of birth
0
Unknown 0112011963
18 Contact phone number
19 Email address
'20 Form of identification used to verify identity
Number
NUnknown
O
Drivers scene/Stale ID O Passport
O Alien Registration Ei Other
Country
00802
21 Cash in amount for individual or entity listed in Item 4
Account number
Issuing State
I 00
22 Cash out amount for individual or entity listed in Item 4
$
60.776
Account number [
I 0 0
Page 3 of 5
SDNY_GM_00049864
IDENTIAL
DB-SONY-00 12688
EFTA_00 160472
EFTA01291938
---PAGE BREAK---
Part II Amount and Type of Transaction(s). Check all boxes that apply.
'23 Date of transaction 01/3112014
24
O Armored car (FI Contract)
K ATM
K Mail Deposit or Shipment
K Night Deposit
K Aggregated transactions
'25 CASH IN: (in U.S. dollar equivalent)
a Deposit(s)
b Payment(s)
c Currency received for funds
tranalin(s) out
d Purchase of negotiable instrument (s)
e Cuirency exchanges)
Currency to prepaid nouns
g Purchases of casinos °hada, tokens
and other gaming instruments
h Currency vrager(s) including
money plays
Bills inserted into gaining devices
z Other (specify):
.00
.00
.00
00
.00
00
00
.00
.00
Total Cash in
.00
26 Foreign Cash in
28 Foreign Cash out
15,000
'27 CASH OUT: (In U.S. dollar equivalent)
a Withdrawal(s)
b Advance(s) on credit Including markers)
C Costing pad from funds tram/m(s)in
d Negotiable instrument(s) cashed
e Currency exchange(%)
Currency from prepaid aeons
a
h
Z Other (specify)
00
.00
.00
40,000,00
20,776.00
.00
Redemplion(s)o/ casks, chips. tokens,
TITO tickets and other gaming instruments
Payments) on wasegs) (including nice
and OTB or sports noon
Travel and complimentary expenses and
Cook gaming Incentives
Payment for tournament. contest or other
promotions
Total Cash out
Foreign Country
Foreign Country
$
00
.00
.00
.00
.00
60.775.00
BE
0 0
0 0
Page 4 of S
SDNY_GM_00049865
CONFIDENTIAL - PURSUANT TO FED. R.cON(E
IDENTIAL
DB-SONY-00 12689
EFTA_00 160473
EFTA01291939
---PAGE BREAK---
Part III Financial Institution Where Transaction(s) Takes Place 1
of 1
0
0
17 Type of financial institution
Other (specify)
19 Primary federal regulator
Depository institution
Federal Reserve Board (FRB)
38 If 37a - Casino/Card Club is checked, indicate type (chedc only one)
K State licensed casino
0 Tribal authorized casino
K Card dub
K Other
'30 Legal name of financial institution
Deutsche Bank Trust Company Americas
31 Alternate name, e.g. trade name. OSA
'32 EIN
'33 Address
'34 City
15 State
! 134941247
346 Park Ave
New York
I ■
'36 ZIP Code
j10154
39 Financial institution 10 type
ID number
'40 Contact ofrce
'41 Phone number
'42 Date Filed
DB PB AML
Ext.
(Dale filed will be auto
-populated when Ihe form is signed.)
Page 5 of 5
SDNY_GM_00049866
IDENTIAL
DB-SONY-00 12690
EFTA_00160474
EFTA01291940