EFTA01291936.pdf

WARNING: PRINTED VERSIONS OF THE BSA E-FILING FORMS ARE NOT FOR SUBMISSION AND WILL NOT BE PROCESSED BY FINCEN. Currency Transaction Report Version Number 1.1 OMB No. 1506-0064 Filing Name 162.6248 9 Type of filing Minitel report ❑ Correct ia mend prior report ❑ 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  WARNING: PRINTED VERSIONS OF THE BSA E-FILING FORMS ARE NOT FOR SUBMISSION AND WILL NOT BE PROCESSED BY FINCEN. Part I Person Involved in Transaction 1 of 2 00 '2 n Person conducting FloPerson conducting r—. Person on whose behalf a- - transaction on own behalf Service b law transaction for another c 1—, transaction was conducted d O c4urier (private) 3 O Multiple transactions Check ❑ If entity '4 Indwiduabe last name O Unknown Seller or entitys legal name •5 First name O Unknown Harry 6 Middle name Suffix 7 Gender Male 8 Alternate Name 9 Occupation or type of business Accountant 9a NAICS Code '10 Address O Unknown '11 City O Unknowil •12 State ❑Unknown [ '13 ZIP/Postal Code 0 Unknown • •14 Country 0 Unknown US •15 TIN 0 Unknown 16 TIN type SSN4TIN •17 Date of birth 0 Unknowl 18 Contact phone number Ext. 19 E-mail address '20 Form of identification used to verify identity OUnknown ig Drivers koensetState ID ❑ Passport O Alien Registration O Other Number 628678340 Country US Issuing State • 21 Cash in amount for individual or entity listed in Item 4 Account number I 00 22 Cash out amount for Individual or entity listed in Item 4 $ 60.776 Account number) 10 • Page 2 of 5 SDNY_GM_00049863 CONFIDENTIAL - PURSUANT TO FED. R.QPN(F IDENTIAL DB-SONY-0012687 EFTA_0016O47 I EFTA01291937  WARNING: PRINTED VERSIONS OF THE BSA E-FILING FORMS ARE NOT FOR SUBMISSION AND WILL NOT BE PROCESSED BY FINCEN. Part I Person Involved in Transaction 2 of 2 00 '2 a rn Person conducting r—r Person conducting — Person on whose behalf ❑ b 1- 1 transaction for another d Service I—I transaction on own behalf c 16 ' transaction was conducted Cslal"r (rx"ed 3 O Multiple transactions Check O If entity '4 Individuars last name O Unknown Epstein or entity's legal name •5 First name O Unknown Jeffrey 6 Middle name Suffix 7 Gender Male 8 Alternate Name 9 Occupation or type of business 9a NAICS Code '10 Address O Unknown 6100 Red Hook Quarter 83 '11 City 0 Unknown I St. Thomas °unknown •12 State VI '13 ZIP/Postal Code 0 Unknown 00802 •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 NUnknown O Drivers scene/Stale ID O Passport O Alien Registration Ei Other Number Country Issuing State 21 Cash in amount for individual or entity listed in Item 4 Account number I 00 22 Cash out amount for individual or entity listed in Item 4 $ 60.776 Account number [ I0 0 Page 3 of 5 SDNY_GM_00049864 CONFIDENTIAL - PURSUANT TO FED. R.QPN(F IDENTIAL DB-SONY-0012688 EFTA_00160472 EFTA01291938  WARNING: PRINTED VERSIONS OF THE BSA E-FILING FORMS ARE NOT FOR SUBMISSION AND WILL NOT BE PROCESSED BY FINCEN. 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) ❑ ATM ❑ Mail Deposit or Shipment ❑ Night Deposit ❑ Aggregated transactions '25 CASH IN: (in U.S. dollar equivalent) '27 CASH OUT: (In U.S. dollar equivalent) a Deposit(s) a Withdrawal(s) 00 b Payment(s) .00 b Advance(s) on credit Including markers) .00 c Currency received for funds tranalin(s) out .00 C Costing pad from funds tram/m(s)in .00 d Purchase of negotiable instrument (s) .00 d Negotiable instrument(s) cashed 40,000,00 e Cuirency exchanges) 00 e Currency exchange(%) 20,776.00 Currency to prepaid nouns .00 Currency from prepaid aeons .00 g Purchases of casinos °hada, tokens a Redemplion(s)o/ casks, chips. tokens, and other gaming instruments 00 TITO tickets and other gaming instruments 00 h Currency vrager(s) including h Payments) on wasegs) (including nice money plays 00 and OTB or sports noon .00 Travel and complimentary expenses and Bills inserted into gaining devices .00 Cook gaming Incentives .00 Payment for tournament. contest or other z Other (specify): promotions .00 .00 Z Other (specify) .00 Total Cash in .00 Total Cash out $ 60.775.00 26 Foreign Cash in Foreign Country 0 0 28 Foreign Cash out 15,000 Foreign Country BE 0 0 Page 4 of S SDNY_GM_00049865 CONFIDENTIAL - PURSUANT TO FED. R.cON(E IDENTIAL DB-SONY-0012689 EFTA_00160473 EFTA01291939  WARNING: PRINTED VERSIONS OF THE BSA E-FILING FORMS ARE NOT FOR SUBMISSION AND WILL NOT BE PROCESSED BY FINCEN. Part III Financial Institution Where Transaction(s) Takes Place 1 of 1 0 0 17 Type of financial institution Depository institution Other (specify) 19 Primary federal regulator Federal Reserve Board (FRB) 38 If 37a - Casino/Card Club is checked, indicate type (chedc only one) ❑ State licensed casino 0 Tribal authorized casino ❑ Card dub ❑ Other '30 Legal name of financial institution Deutsche Bank Trust Company Americas 31 Alternate name, e.g. trade name. OSA '32 EIN ! 134941247 '33 Address 346 Park Ave '34 City New York 15 State I■ '36 ZIP Code j10154 39 Financial institution 10 type ID number '40 Contact ofrce DB PB AML '41 Phone number Ext. '42 Date Filed (Dale filed will be auto -populated when Ihe form is signed.) Page 5 of 5 SDNY_GM_00049866 CONFIDENTIAL - PURSUANT TO FED. R.CON(F IDENTIAL DB-SONY-00 12690 EFTA_00160474 EFTA01291940