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IRS Report of Cash Payments Over $10,000 FinCEN
Form
Form 8300 Received in a Trade or Business 8300
(Rev. August 2014) ▶ See instructions for definition of cash. (Rev. August 2014)
OMB No. 1506-0018
▶ Use this form for transactions occurring after August 29, 2014. Do not use prior versions after this date.
Department of the Treasury Department of the Treasury
Internal Revenue Service For Privacy Act and Paperwork Reduction Act Notice, see the last page. Financial Crimes
Enforcement Network
1 Check appropriate box(es) if: a Amends prior report; b Suspicious transaction.
Part I Identity of Individual From Whom the Cash Was Received
2 If more than one individual is involved, check here and see instructions . . . . . . . . . . . . . . . . . . . . ▶
3 Last name 4 First name 5 M.I. 6 Taxpayer identification number
7 Address (number, street, and apt. or suite no.) 8 Date of birth . . . ▶ M M D D Y Y Y Y
(see instructions)
9 City 10 State 11 ZIP code 12 Country (if not U.S.) 13 Occupation, profession, or business
14 Identifying a Describe ID ▶ b Issued by ▶
document (ID) c Number ▶
Part II Person on Whose Behalf This Transaction Was Conducted
15 If this transaction was conducted on behalf of more than one person, check here and see instructions . . . . . . . . . . . ▶
16 Individual’s last name or organization’s name 17 First name 18 M.I. 19 Taxpayer identification number
20 Doing business as (DBA) name (see instructions) Employer identification number
21 Address (number, street, and apt. or suite no.) 22 Occupation, profession, or business
23 City 24 State 25 ZIP code 26 Country (if not U.S.)
27 Alien a Describe ID ▶ b Issued by ▶
identification (ID) c Number ▶
Part III Description of Transaction and Method of Payment
28 Date cash received 29 Total cash received 30 31 Total price if different from
M M D D Y Y Y Y If cash was received in item 29
more than one payment,
$ .00 check here . . . ▶ $ .00
32 Amount of cash received (in U.S. dollar equivalent) (must equal item 29) (see instructions):
a U.S. currency $ .00 (Amount in $100 bills or higher $ .00 )
b Foreign currency $ .00 (Country ▶ )
c Cashier’s check(s) $ .00 Issuer’s name(s) and serial number(s) of the monetary instrument(s) ▶
d Money order(s) $ .00
e Bank draft(s) $ .00
f Traveler’s check(s) $ .00 }
33 Type of transaction 34 Specific description of property or service shown in
a Personal property purchased f Debt obligations paid 33. Give serial or registration number, address, docket
b Real property purchased g Exchange of cash number, etc. ▶
c Personal services provided h Escrow or trust funds
d Business services provided i Bail received by court clerks
e Intangible property purchased j Other (specify in item 34) ▶
Part IV Business That Received Cash
35 Name of business that received cash 36 Employer identification number
37 Address (number, street, and apt. or suite no.) Social security number
38 City 39 State 40 ZIP code 41 Nature of your business
42 Under penalties of perjury, I declare that to the best of my knowledge the information I have furnished above is true, correct,
and complete.
▲ ▲
Signature Title
Authorized official
43 Date of M M D D Y Y Y Y 44 Type or print name of contact person 45 Contact telephone number
signature
IRS Form 8300 (Rev. 8-2014) Cat. No. 62133S FinCEN Form 8300 (Rev. 8-2014)
