Introductory BSA/AML Examiner School, Atlanta, CA

WARNING: PRINTED VERSIONS OF THE BSA E-FILING FORMS ARE NOT FOR SUBMISSION AND WILL NOT BE PROCESSED BY FinCEN.

PartIIAmountandTypeofTransaction(s).Checkallboxesthatapply. *23 Date of transaction 1/22/2014 24

Armored car (FI

ATM

Mail deposit or

Night deposit

Aggregated

transactions

contract)

shipment

*25 CASHIN: (inU.S. dollar equivalent)

*27 CASHOUT: (inU.S. dollar equivalent)

a Withdrawal(s) $

a Deposit(s) $ 9608.00

bAdvance(s) on credit (including markers) $ c Currencypaid from funds transfer(s) in $

b Payment(s) $

c Currencyreceived for funds transfer(s) out $

d Purchase of negotiable instrument(s) $ 4670.00

d Negotiable instrument(s) cashed $

e Currencyexchange(s) $

e Currencyexchange(s) $

f Currencyfrom prepaid access $

f Currencyto prepaid access $

g Purchases of casinos chips, tokens and other gaming instruments $

g Redemption(s) of casino chips, tokens, TITO tickets and other gaming instruments $

h Currencywager(s) including moneyplays $

h Payment(s) on wagers(s) (including race and OTB or sports pool) $ i Travel and complimentaryexpenses and book gaming incentives $

i Bills inserted into gaming devices $

zOther (specify):

j Payment for tournament, contest or other promotions $

$

zOther (specify):

$

Total Cash in $ 14278.00

Total Cashout $

26 ForeignCash in $ 0.00 28 ForeignCashout $ 0.00

ForeignCountry ForeignCountry

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