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Fillable FinCEN FORM 104 (Rev. 12-2003) - fincen

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FINCEN Form 104 a Currency Transaction Report Previous editions will not be accepted after September, 2011. Please type or print. (Complete all parts that apply--See Instructions) OMB No. 1506-0004 (March 2011) Department of the Treasury FinCEN 1 Check all box(es) that apply: Amends prior report b Multiple persons c Multiple transactions Part I Person(s) Involved in Transaction(s) 3 First name 6 SSN or...
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