Fillable Fincen Form 103 - Multiple Persons Or Multiple Agents

FinCEN Form103 (Rev. 3-03)

Page 4

or Items 31a through 31i, specify the type of

amount only equals $9,000, which does not meet

Item 43. Date the form is signed.—The approving

transaction and the amount of currency in Item 30h

the BSA reporting threshold.

official must enter the date the Form 103 is signed.

For proper format, see the instructions for Item 12

or 31j, respectively. Enter the total amount of the

Example 3. Person C deposits $7,000 in currency

above.

reportable Cash In transaction(s) in Item 30i. Enter

to his front money account and pays $9,000 in

the total amount of the reportable Cash Out

currency to pay off an outstanding credit balance (two

Item 44. Preparer’s name.—Type or print the full

transaction(s) in Item 31k.

Cash In entries); receives $2,500 in currency from a

name of the individual preparing Form 103. The

If less than a full dollar amount is involved increase

withdrawal from a safekeeping account, $2,500 in

preparer and the approving official may be different

the figure to the next higher dollar. For example, if

currency from a wire transfer and cashes a personal

individuals.

the currency total is $20,500.25, show it as

check of $7,500 (three Cash Out entries); and

$20,501.00.

presents Canadian dollars which are exchanged for

Items 45 and 46. Contact person/telephone

If there is a currency exchange, list it separately

$1,500 in U.S. dollar equivalent. Complete Form 103

number.—Type or print the name and commercial

with both the Cash In and Cash Out totals. If foreign

as follows:

telephone number of a responsible individual to

currency is exchanged, use the U.S. dollar equivalent

Cash In of “$7,000” is entered in Item 30b

contact concerning any questions about this Form

103.

on the day of the transaction.

(deposit), “$9,000” is entered in Item 30c (payment

Payment(s) on credit, Item 30c, includes all forms

on credit), “$1,500” is entered in Item 30g (currency

of cash payments made by a customer on a credit

exchange), and a Cash In total of “$17,500” is entered

Paperwork Reduction Act Notice.—The requested

account or line of credit, or in redemption of markers

in Item 30i. Cash Out of “$2,500” is entered in Item

information is useful in criminal, tax, and regulatory

or counter checks. Currency received from wire

31b (withdrawal of deposit), “$2,500” is entered in

investigations and proceedings. Financial institutions

transfer(s) out, Item 30e, applies to cash received from

Item 31e (wire transfer), “$7,500” is entered in Item

are required to provide the information under 31

U.S.C. 5313 and 31 CFR Part 103, commonly referred

a customer when the casino sends a wire transfer on

31f (negotiable instrument cashed), “$1,500” is

behalf of a customer.

entered in Item 31g (currency exchange) and a Cash

to as the Bank Secrecy Act (BSA).

Currency paid from wire transfer(s) in, Item 31e,

Out Total of “$14,000” is entered in Item 31k. In this

The BSA is administered by the U.S. Department

applies to cash paid to a customer when the casino

example, both the Cash In and Cash Out totals exceed

of the Treasury’s Financial Crimes Enforcement

receives a wire transfer on behalf of a customer. Travel

$10,000, and each must be reflected on Form 103.

Network (FinCEN). You are not required to provide

the requested information unless a form displays a

and complimentary expenses and gaming incentives,

Item 31h, includes reimbursements for a customer’s

Example 4. Person D purchases $10,000 in chips

valid OMB control number. The time needed to

travel and entertainment expenses and cash

with currency and places a $10,000 cash bet (two

complete this form will vary depending on individual

complementaries (“comps”).

Cash In entries); and later receives currency for an

circumstances. The estimated average time is 19

$18,000 redemption of chips and $20,000 from a

minutes.

Send comments regarding this burden

estimate, including suggestions for reducing the

Determining Whether Transactions

payment on a cash bet (two Cash Out entries).

burden, to the Office of Management and Budget,

Meet The Reporting Threshold

Complete Form 103 as follows:

Cash In of “$10,000” is entered in Items 30a and

Paperwork Reduction Project, Washington, DC 20503

Only cash transactions that, alone or when

30d and a Cash In total of “$20,000” is entered in

and to the Financial Crimes Enforcement Network,

aggregated, exceed $10,000 should be reported on

Item 30i. Cash Out of “$18,000” is entered in Item

Attn.: Paperwork Reduction Act, P .O. Box 39, Vienna

Form 103. A casino must report multiple currency

31a (redemption of chips), “$20,000” is entered in

VA 22183-0039.

transactions when it has knowledge that such

Item 31d (payment on bets) and a Cash Out Total of

transactions have occurred. This includes knowledge

“$38,000” is entered in Item 31k. In this example,

gathered through examination of books, records, logs,

both the Cash In and Cash Out totals exceed $10,000,

information retained on magnetic disk, tape or other

and each must be reflected on Form 103.

machine-readable media, or in any manual system,

and similar documents and information that the

Item 32. Date of transaction.—Enter the gaming day

casino maintains pursuant to any law or regulation

on which the transaction occurred (see What To File

or within the ordinary course of its business.

above). For proper format, see the instructions

Cash In and Cash Out transactions for the same

forItem 12 above.

customer are to be aggregated separately and must

not be offset against one another. If there are both

Item 33. Foreign currency.—If foreign currency is

Cash In and Cash Out transactions which each exceed

involved, identify the country of issuance by entering

$10,000, enter the amounts in Items 30 and 31 and

the appropriate two-letter country code. If multiple

report on a single Form 103.

foreign currencies are involved, identify the country

for which the largest amount in U.S. dollars is

Example 1. Person A purchases $11,000 in chips

exchanged.

with currency (one Cash In entry); and later receives

currency from a $6,000 redemption of chips and a

Part III. Casino Reporting Transaction(s)

$2,000 slot jackpot win (two Cash Out entries).

Complete Form 103 as follows:

Item 34. Casino’s trade name.—Enter the name by

Cash In of “$11,000” is entered in Item 30a

which the casino does business and is commonly

(purchase of chips) and Cash In Total of “$11,000” is

known. Do not enter a corporate, partnership, or

entered in Item 30i. No entry is made for Cash Out.

other entity name, unless such name is the one by

The two Cash Out transactions equal only $8,000,

which the casino is commonly known.

which does not meet the BSA reporting threshold.

Item 35. Casino’s legal name.—Enter the legal name

Example 2. Person B deposits $5,000 in currency

as shown on required tax filings, only if different from

to his front money account and pays $10,000 in

the trade name shown in Item 34. This name will be

currency to pay off an outstanding credit balance (two

defined as the name indicated on a charter or other

Cash In entries); receives $7,000 in currency from a

document creating the entity, and which is identified

wire transfer (one Cash Out entry); and presents

with the casino’s established EIN.

$2,000 in small denomination U.S. currency to be

exchanged for an equal amount in U.S. $100 bills.

Item 36. Employer identification number (EIN).—

Complete Form 103 as follows:

Enter the casino’s EIN.

Cash In of “$5,000” is entered in Item 30b

(deposit), “$10,000” is entered in Item 30c (payment

Items 37, 38, 39, and 40. Address.—Enter the street

on credit), “$2,000” is entered in Item 30g (currency

address, city, state, and ZIP code of the casino (or

exchange), and Cash In Total of “$17,000” is entered

branch) where the transaction occurred. Do not use

in Item 30i. In determining whether the transactions

a P.O. box number.

are reportable, the currency exchange is aggregated

with both the Cash In and the Cash Out amounts.

Items 41 and 42. Title and signature of

The result is a reportable $17,000 Cash In transaction.

approving official.—The official who is authorized

No entry is made for Cash Out. The total Cash Out

to review and approve Form 103 must indicate his/

her title and sign the form.

Fincen Form 103 - Multiple Persons Or Multiple Agents - 2003 Page 3

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