EFTA01291931.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 152-5244 '1 Type of filing Z Initial report ❑ Corredsmend prior report ❑ FinCEN directed Backfiling Document Control Number / BSA Identifier J 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_00049857 CONFIDENTIAL - PURSUANT TO FED. R.CON(F IDENTIAL DB-SDNY-0012681 EFTA_00160465 EFTA01291931  WARNING: PRINTED VERSIONS OF THE BSA E-FILING FORMS ARE NOT FOR SUBMISSION AND WILL NOT BE PROCESSED BY FINCEN. Part 1 Person Involved in Transaction 1 of 2 00 a Person conducting Person conducting pvl Person on whose behalf ❑ transaction on own behalf b ® transaction was conducted d ❑ Courier Service (private) I—I transaction for another 3 ❑ Multiple transactions Check ❑ If entity '4 Individuabs last name ❑ Unknown Epstein or entilys legal name '5 First name ❑ Unknown Jeffrey 6 Middle name Suffix 7 Gender Male 8 Alternate Name 9 Occupation or type of business 9a NAICS Code '10 Address ❑ Unknown 6100 Red Hook quarter 83 '11 City ❑ Unknown I ST. Thomas '12 State ❑Unknown VI '13 ZIP/Postal Code ❑ Unknown '14 Country ❑ Unknown I. US '5 TIN ❑ Unknown 18 TIN type SSNJTIN '17 Date of birth ❑ Unknown 0112011963 18 Contact phone number Ext. 19 E-mail address '20 Form of identification used to verify identity Ei Unknown ❑ Drivers ecense/State ID ❑ Passpon ❑ Alien Registration ❑ Other Number Country Issuing State 2t 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 $ 21.160 Account number[ 0 Page 2 of 5 SDNY_GM_00049858 CONFIDENTIAL - PURSUANT TO FED. R.CON(F IDENTIAL DB-SONY-0012682 EFTA_00160466 EFTA01291932  WARNING: PRINTED VERSIONS OF THE BSA E-FILING FORMS ARE NOT FOR SUBMISSION AND WILL NOT BE PROCESSED BY FINCEN. Part 1 Person Involved in Transaction 2 of 2 00 a O Person conducting Person conducting Person on whose behalf ❑ '2 Courier transaction on own behalf b law transaction for another c O transaction was conducted d Service (Private) 3 O Multiple transactions Check ❑ If entity '4 Individual's last name O Unknown Beller or entity's 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 6412 '10 Address O Unknown 12 Golar Dr •11 City O Unknown Monsey •12 State O Unknown NY '13 ZIP/Postal Code 0 Unknown 10952 '14 Country O Unknown I. US '15 TIN 0 Unknown 16 TIN type SSN4TIN '17 Date of birth 0 Unknown 18 Contact phone number Ext. 19 E-mail address '20 Form of identification used to verify identity OUnknown IX Drivers kcense/State ID O Passport O Alien Registration O Other Number Country US Issuing State NY 21 Cash in amount for individual or entity listed in Item 4 $ Account number 0 0 22 Cash out amount for irxhvidual or entity listed in Item 4 21.150 Account number a Page 3 of 5 SDNY_GM_00049859 CONFIDENTIAL - PURSUANT TO FED. R.CON(F IDENTIAL DB-SONY-0012683 EFTA_00I60467 EFTA01291933  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 12J19!2013 24 ❑ 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 Inathdrawal(s) b Payrnant(s) .00 b Advance(s) on aedit (Including markers) .00 c Currency received for funds transfor(s) out .00 c Currency pad horn funds trander(s) In .00 d Purchase of negotiable instrument (a) .00 d Negotiable instrumen(s) cashed .00 e Currency oxchange(s) 00 e Currency exchange(s) 21,160.00 I Currency to prepaid access .00 f Currency from prepaid access .00 g Purchases of casinos chips, tokens a Redemphon(s) of casino chips. tokens. and other gaming instruments 00 TITO tickets end other gaining Instruments 00 h Currency wager(s) ecluding h Pa/mantis) on wagerts) (Including race money pay's .00 and OTB or spans pool) .00 I Travel and complimentary expenses and I Bills inserted irnogarniag devices .00 book gaming Incentives .00 I Payment for tournament, contest or other t Other (specify): promotions .00 .00 z Other (specify) .00 Total Cash in .00 Total Cash out 21,16000 26 Foreign Cash in Foreign Country 0 0 28 Foreign Cash out 16,100 Foreign Country BE 0 0 Page 4 of 5 SDNY_GM_00049860 CONFIDENTIAL - PURSUANT TO FED. R.CON(F IDENTIAL DB-SONY-0012684 EFTA_00I 60468 EFTA01291934  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 '37 Type of financial institution Depository institution Other (specify) '29 Primary federal regulator Federal Reserve Board (FRB) 38 If 37a - Casino/Card Club is checked, indicate type (chedc only one) ❑ State licensed casino ❑ Tribal authorized casino 0 Card club ❑ Other '30 Legal name of financial institution Deutsche Bank Trust Company Americas 31 Alternate name, e.g. trade name, DBA '32 EIN '33 Address 346 Park Ave '34 City New York '35 Slate NY '36 ZIP Code j10154 39 Financial institution 10 type ID number '40 Contact office DB PB AML '41 Phone number Ext. '42 Date Filed (Dale filed will be auto -populated when des form is signed.) Page 5 of 5 SDNY_GM_00049861 CONFIDENTIAL - PURSUANT TO FED. R.CON(F IDENTIAL DB-SONY-0012685 EFTA_00160469 EFTA01291935