Fillable Form FinCEN 104 (Rev. 12-2003) - irs

FINCEN Form 104 Currency Transaction Report Previous editions will not be accepted after August 31, 2004. Please type or print. (Complete all parts that apply--See Instructions) OMB No. 1506-0004 (Formerly Form 4789) (Eff. December 2003) Department of the Treasury FinCEN 1 Check all box(es) that apply: a Amends prior report b Multiple persons c Multiple transactions Part I Person(s) Involved in Transaction(s) 3 First name 6 SSN or EIN 8 Date of birth 4 Middle initial Section A--Person(s) More

This Currency Transaction Report (CTR) should NOT be filed for suspicious ... currency, then both a CTR and the appropriate Suspicious. Activity Report form ... Less