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.

PartIPersonInvolvedinTransaction3of3 *2 Person conducting transaction on own behalf Person conducting transaction for another

Person on whose behalf

Courier service (private)

transaction is conducted

3

Multiple transactions

Check If entity *4 Individual's last name or entity's legal name

Unknown BUTLER

*5 First name 6 Middle name

Unknown KENNETH

W

Suffix 7 Gender 8 Alternate Name 9 Occupationor type of business

CLASSIC CAR RESTORER

9a NAICSCode *10 Address

Unknown 40 COUNTRYVIEWLN

*11 City

Unknown OROVILLE

*12 State

*13 ZIP/Postal Code

Unknown CA

Unknown 95966

*14 Country

Unknown US

*15 TIN

16 TINtype

Unknown 557139231

SSN/ITIN

*17 Date of birth Unknown 11/27/1957 18 Contact phone number Ext. 19 E-mail address *20 Formof identificationused toverify identity

Unknown

Passport Alien registration Other

Driver's license/State ID

Number

Country

IssuingState

N3779367 CA 21 Cash inamount for individual or entity listed in Item4 $ 4670.00 Account number 22 Cashout amount for individual or entity listed in Item4 $ 0.00 Account number US

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