Fillable Registration of Money FinCEN Form 107 Services Business (IRS)

Fill Online, Printable, Fillable, Blank Registration of Money FinCEN Form 107 Services Business (IRS) Form

Use Fill to complete blank online IRS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Registration of Money FinCEN Form 107 Services Business (IRS)

On average this form takes 24 minutes to complete

The Registration of Money FinCEN Form 107 Services Business (IRS) form is 2 pages long and contains:

  • 0 signatures
  • 73 check-boxes
  • 63 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your IRS forms online.

The Internal Revenue Service (IRS) is a government agency responsible for collecting taxes and administering the federal statutory tax laws of the United States. The IRS provide tax assistance to taxpayers and pursue and resolve fraudulent tax filings.

BROWSE IRS FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Registration of Money
Services Business
FinCEN Form 107
March 2011
Previous editions will not be
accepted after September 30, 2011.
Please type or print. Always complete entire report.
22 SSN/ITIN (individual), EIN (entity)
16 City
17 State
18 ZIP Code/Postal Code
12 Individual’s last name, or organization’s name
13 First name
14 Middle initial
15 Address
19 Country (if other than US)
21 Date of birth
Part I Filing Information
Part III Owner or Controlling Person
20 Telephone number - (include area code)
Part IV Money Services and Product Information
24 States and/or territories where the registrant, its agents or branches are located. Check box a, b, or c as appropriate (Check only one) and
do not check individual state/territory boxes. If box a, b, or c does not apply, check as many state/territory boxes as necessary.
Alabama (AL)
Alaska (AK)
American Somoa (AS)
Arizona (AZ)
Arkansas (AR)
California (CA)
Colorado (CO)
Connecticut (CT)
Delaware (DE)
District of Columbia (DC)
FS of Micronesia (FM)
Florida (FL)
Georgia (GA)
Guam (GU)
Hawaii (HI)
Idaho (ID)
Illinois (IL)
Indiana (IN)
Iowa (IA)
Kansas (KS)
Kentucky (KY)
Louisiana (LA)
Maine (ME)
Marshall Islands (MH)
Maryland (MD)
Massachusetts (MA)
Michigan (MI)
Minnesota (MN)
Mississippi (MS)
Missouri (MO)
Montana (MT)
Nebraska (NE)
Nevada (NV)
New Hampshire (NH)
New Jersey (NJ)
New Mexico (NM)
New York (NY)
North Carolina (NC)
North Dakota (ND)
N. Mariana Isls. (MP)
Ohio (OH)
Oklahoma (OK)
Oregon (OR)
Palau (PW)
Pennsylvania (PA)
Puerto Rico (PR)
Rhode Island (RI)
South Carolina (SC)
South Dakota (SD)
Tennessee (TN)
Texas (TX)
Utah (UT)
Vermont (VT)
Virgin Islands (VI)
Virginia (VA)
Washington (WA)
West Virginia (WV
Wisconsin (WI)
Wyoming (WY)
1 Indicate the type of filing by checking a, b, or d below (Check only one). If filing a correction, check “c” and either a, b, or d.
a Initial registration b Renewal c Correcting a prior filing d Re-registration
2 If you checked item 1 d please indicate the reason(s). Check all that apply.
a Re-registered under state law b More than 10 percent transfer of equity interest c More than 50 percent increase in agents
a Driver’s license/state ID b Passport c Alien registration z Other _________________________
e ID number f Issuing state or country
23 Skip this item if you completed item 22.
If the owner or controlling person is an individual enter their form of identification, the ID number, and the issuing state or country.
______ / ______ / _______
MM DD YYYY
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
*3 Legal name of the money services business
4 Doing business as
*5 Address
10 Telephone number (include area code)
*6 City
*9 EIN (entity), SSN/ITIN (individual)
Part II Registrant Information
Complete and send to: Enterprise Computing Center-Detroit, Attn: Money Services Business Registration, P. O. Box 33116, Detroit, MI 48232-0116
Catalog Number 39578N Rev. 3/11
OMB No.1506-0013
See instructions for items marked with an asterisk ( * ).
*7 State
8 ZIP Code
_ _ _
11 E-mail address (If available)
a All States & Territories b All States c All Territories
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
(
)
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
(
)
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
Part IV (continued)
2
26 Money services business activities of the registrant. Check as many as apply. See instructions for an explanation of the terms ” issuer”,
“seller”, “redeemer”, “check casher”, and “money transmitter”.
a Issuer of traveler’s checks
b Seller of traveler’s checks
c Redeemer of traveler’s checks
d Issuer of money orders
e Seller of money orders
f Redeemer of money orders
h Check casher
g Currency dealer or exchanger
i Money transmitter
30 If the registrant has more than one transaction account for money services business activities check here.
See instructions for an explanation of the term “transaction account”.
The registrant’s primary transaction account is the one that has the greatest annual dollar amount of money services business activity.
In items 31 through 36 enter information about the registrant’s primary transaction account for money services business activities.
Part V Primary Transaction Account for MSB Activities
If the supporting documentation is kept at the U.S. location reported in Part II check here and continue to Part VII.
34 State 35 ZIP Code
31 Name of financial institution where the primary transaction account is held
32 Address
33 City
36 Primary transaction account number
Part VI Location of Supporting Documentation
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
I am authorized to file this form on behalf of the money services business listed in Part II. I declare that the information provided is true, correct and
complete. I understand that the money services business listed in Part II is subject to the Bank Secrecy Act and its implementing regulations. See 31
CFR Part Chapter X. The money services business listed in Part II maintains a current list of all agents, an estimate of its business volume in the
coming year, and all other information required to comply with 31 U.S.C. 5330 and the regulations thereunder. The signature of the owner,
controlling person or authorized corporate officer is mandatory.
38 City
39 State
40 ZIP Code
37 Address
Part VII Authorized Signature
_ _ _
28 Is any part of the registrant’s money services business conducted as a mobile operation?
27 Is any part of the registrant’s money services business an informal value transfer system?
See the explanation of “money transmitter” in the instructions.
a Yes b No
a Yes b No
d Money order redemption
29 Enter the number of agents authorized to conduct each money services business activity. Do not include branches, or persons who are
solely employees. See instructions for an explanation of the term “agent”.
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
a Traveler’s check sales
b Traveler’s check redemption
c Money order sales
e Currency exchange
or dealer
f Check cashing
g Money transmission
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
41 Signature
42 Print name
43 Title
44 Date of signature
______ / _____ / _______
MM DD YYYY
25 Enter the number of branches of the registrant. Reminder: do not separately register each branch.
See instructions for an explanation of the term “branch”.
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
_ _ _
General Information
Who Must Register
Generally each money services business must
register with the Department of the Treasury. This
form must be used by a money services business
(also referred to as an MSB) to register. However,
not all MSBs are required to register. For example,
if you are an MSB solely because you are an agent
of another MSB, you are not required to register.
The discussion below will help you determine
whether or not you are an MSB that is required to
register. For more information visit www.msb.gov.
The term money services business includes:
1. Currency dealers or exchangers who exchange
more than $1,000 for any one customer on any
day.
2. Check cashers who cash checks totaling more
than $1,000 for any one customer on any day.
3. Issuers of traveler’s checks, money orders or
stored value who issue more than $1,000 in
traveler’s checks, money orders or stored value
for any one customer on any day.
4. Sellers of traveler’s checks, money orders or
stored value who sell more than $1,000 in traveler’s
checks, money orders or stored value for any one
customer on any day.
5. Redeemers of traveler’s checks, money orders
or stored value who redeem more than $1,000 in
traveler’s checks, money orders or stored value
for any one customer on any day.
6. Money transmitters.
7. U.S. Postal Service.
The following are not required to register:
1. A business that is an MSB solely because it serves
as an agent of another MSB. For example, a
supermarket corporation that sells money orders
for an issuer of money orders is not required to
register. This is true even if the supermarket
corporation serves as an agent for two or more
MSBs. However, an MSB that serves as an agent of
another MSB and engages in MSB activities on its
own behalf must register . For example, a
supermarket corporation must register if, in addition
to acting as an agent of the money order issuer, it
provides check cashing or currency exchange
services on its own behalf in an amount greater
than $1,000 for any one person on any day.
2. The United States Postal Service, any agency of
the United States, of any state, or of any political
subdivision of any state.
3. At this time, persons are not required to register
to the extent that they issue, sell or redeem stored
value. If, however , a money services business
provides money services in addition to stored
value, the provision of stored value services does
not relieve it of the responsibility to register , if
required, as a provider of those other services.
For the regulatory definition of “money services
business” see 31 CFR 1010.100(t) and (ff).
The following terms are used in the form and
instructions to describe a money services business:
1. An “agent” is a separate business entity from the
issuer that the issuer authorizes, through written
agreement or otherwise, to sell its instruments or,
in the case of funds transmission, to sell its send
and receive transfer services. A person who is
solely an employee of the MSB is not an agent of
that MSB.
2. A “branch” is an owned location of either an
issuer or agent at which financial services are sold.
An MSB should not separately register each of its
branches. A mobile operation owned by an MSB is
a branch of that MSB. The MSB’s headquarters is
not a branch. If the MSB has only one location,
that location is not a branch.
3. A “check casher” is a person engaged in the
business of providing cash to persons in return for
a check.
4. A “currency dealer or exchanger” is a person
who engages in the physical exchange of currency
for retail customers.
5. “Informal value transfer system”. See explanation
of the term money transmitter.
6. An “issuer” is the business that is ultimately
responsible for payment of money orders or
travelers checks as the drawer of such instruments,
or a money transmitter that has the obligation to
guarantee payment of a money transfer.
7. A “money transmitter” is a person that engages
as a business in the transfer of funds through a
financial institution.
Generally, acceptance and transmission of funds as
an integral part of the execution and settlement of
a transaction other than the funds transmission itself
(for example, in connection with the bona fide
sale of securities) will not cause a person to be a
money transmitter.
An “informal value transfer system” is a kind of
money transmitter. An informal value transfer
system includes any person who engages as a
business in an informal money transfer system or
any network of people who engage as a business in
facilitating the transfer of money domestically or
internationally outside of the conventional financial
institutions system.
8. A “person” is an individual, a corporation, a
partnership, a trust or estate, a joint stock company,
an association, a syndicate, joint venture, or other
unincorporated organization or group, an Indian
Tribe (as that term is defined in the Indian Gaming
Regulatory Act), and all entities cognizable as legal
personalities.
FinCEN Form 107a Registration of Money Services Business Instructions 1
9. A “redeemer” is a business that accepts
instruments in exchange for currency or other
instruments for which it is not the issuer. You are
not a redeemer if you take the instruments in
exchange for goods or general services, provided
that the amount of cash returned is not more than
$1,000 for any one customer on any day.
10. A “seller” is a business that issuers authorize,
through written agreement or otherwise, to sell
their instruments or their send and receive transfer
services.
11. A “transaction account” is a deposit or account
on which the depositor or account holder is
permitted to make withdrawals by negotiable or
transferable instrument, payment orders of
withdrawal, telephone transfers, or other similar items
for the purpose of making payments or transfers to
third persons or others. Such terms include demand
deposits, negotiable order of withdrawal accounts,
savings deposit subject to automatic transfers, and
share draft accounts. See 12 USC 461(b)(1)(c).
When to Register
Initial registration: File the form within 180 days
after the date the business is established.
Renewal: Each MSB must renew its registration
every two years, on or before December 31. See
31 CFR 1022.380(b)(2). For example, if an MSB
registered on October 15, 2003, it must file a
renewal by December 31, 2004, and then every
24 months thereafter (on or before December 31,
2006, then December 31, 2008, etc.). Renewals
must be submitted on a new Form 107. Photo
copies of previously submitted forms or
facsimiles will not be accepted for renewal
purposes
Correction: Use the form to correct a prior report.
Complete Part I in its entirety and only those other
entries that are being added or changed. Staple a
copy of the prior report (or the acknowledgment
from ECC-D if received) to the corrected report.
Re-registration: Refile a new registration form
when one of the following events occurs:
1. a change in ownership requiring re-registration
under state registration law;
2. more than 10 percent of voting power or equity
interest is transferred (except certain publicly-
traded companies) or;
3. the number of agents increases by more than 50
percent.
Where to Register
Send your completed form to:
Enterprise Computing Center - Detroit
Attn: Money Services Business Registration
P.O. Box 33116
Detroit, MI 48232-0116
Rev. 7/10
The Enterprise Computing Center-Detroit (ECC-
D) will send an acknowledgment of receipt to the
registrant listed in Part II within approximately 60
days after the form is processed (See note below).
ECC-D can respond to general questions over the
phone at telephone (800) 800-2877.
General Instructions
NOTE: All items on FinCEN Form 107 should be
completed fully and accurately. Items marked
with an asterisk (*) must be completed for the
registration to be accepted, processed, and
recorded. Acknowledgment letters will not be
provided if these items are not complete.
1. This form is available on the Financial Crimes
Enforcement Network’s web site for MSBs at
www.msb.gov, or FinCEN’ s web site at
www.fincen.gov, or by calling the IRS Forms
Distribution Center at (800) 829-3676.
2. Unless there is a specific instruction to the
contrary, leave blank any items that do not apply or
for which information is not available.
3. Complete the form by providing as much
information as possible.
4. Do not include supporting documents with this
form.
5. Type or complete the form using block written
letters.
6. Enter all dates in MM / DD / YYYY format
where MM=month, DD=day , and YYYY=year.
Precede any single number with a zero, i.e., 01,02,
etc.
7. List all U.S. telephone numbers with area code
first and then the seven-digit phone number ,
using the format (XXX) XXX-XXXX.
8. Always enter an individual’s name as last name,
first name, and middle initial (if known). If a legal
entity is listed, enter its name in the last name
field.
9. Enter identifying numbers starting from left to
right. Do not include spaces, dashes, or other
punctuation. Identifying numbers include social
security number (SSN), employer identification
number (EIN), individual taxpayer identification
number (ITIN), alien registration number, driver’s
license/state identification, foreign national
identification, and passport number.
10. Enter all Post Office ZIP Codes from left to
right with at least the first five numbers, or with all
nine (ZIP + 4) if known.
11. Addresses: Enter the US permanent street
address, city , two-letter st ate or territory
abbreviation used by the U.S. Postal Service and
ZIP Code (ZIP+4 if known) of the individual or
entity. A post of fice box number should not be
used for an individual, unless no other address is
available. For an individual, also enter any apartment
number, suite number, or road or route number. If
a P.O. Box is used for an entity , enter the street
name, suite number, and road or route number.
If the address of the individual or entity in PART
III is in a foreign country, enter the city, province
or state, postal code and the name of the country.
Complete any part of the address that is known,
even if the entire address is not known. If the
address is in the United States leave country code
blank.
Specific Instructions
Part I Filing Information
See “When to Register” in the General Information
part of these instructions.
Item 1-- Check either box a, b, or d (only one) for
the type of filing. If this report correct s an earlier
filing, check box “c” and either box a, b, or d.
Item 2-- If you checked box 1d, please indicate
the reason by checking boxes a, b, or c (check all
that apply).
Part II Registrant Information
Enter the US State or Territory operating location.
Item *3--Legal name of the money services
business. Enter the full legal name of the registrant
money services business as it is shown on the charter
or other document creating the entity. For example,
enter Good Hope Enterprises, Inc. when the money
services business is Good Hope Enterprises, Inc. If a
sole proprietorship, enter the business name of
the proprietorship.
Item 4-- Doing business as. If applicable, enter the
separate doing business as name of the registrant. For
example, if Good Hope Enterprises, Inc., i s doing
business as “Joe’s Check Cashing” enter in item 4,
Joe’s Check Cashing.
Items *5, *6, *7 and 8-- Address. Enter the
permanent United States address of the registrant’s
US operations that is being registered.
Item *9--EIN (entity), SSN/ITIN (individual). If
the registrant is an entity enter its employer
identification number (EIN). If the registrant is an
individual and a U. S. Citizen or an alien with a
social security number, enter his/her SSN. If the
registrant is an individual who is an alien and has
an individual taxpayer identification number, enter
his/her ITIN.
Item 10-- Telephone number. Enter the telephone
number of the MSB listed in item 3.
Item 11-- E-mail address (Optional). If the MSB
has an e-mail address please enter it here. An e-
mail address may be used to contact the MSB should
questions arise regarding their registration.
FinCEN Form 107 Registration of Money Services Business Instructions
2
Part III Owner or Controlling Person
General: Any person who owns or controls a
money services business is responsible for
registering the MSB. Only one registration form is
required for any business in any registration period.
If more than one person owns or controls the
business, they may enter into an agreement
designating one of them to register the business.
The designated owner or controlling person must
complete Part III and provide the requested
information. In addition, that person must sign and
date the form as indicated in Part VII. Failure by
the designated person to register the business does
not relieve any other person who owns or controls
the business of the liability for failure to register
the business.
An “Owner or Controlling Person” includes the
following:
Registrant Business Owner or
Controlling Person
Sole Proprietorship................. the individual who
owns the business
Partnership..............................a general partner
Trust........................................ a trustee
Corporation.............................the largest single
shareholder
If two or more persons own equal numbers of
shares of a corporation, those persons may enter
into an agreement as explained above that one of
those persons may register the business.
If the owner or controlling person is a corporation, a
duly authorized officer of the owner-corporation may
execute the form on behalf of the owner-corporation.
Item 12--Individual’s last name, or organization’s
name. If the registrant is a publicly held corporation,
it is sufficient to write “public corporation” in item
12. Where registrant is a public corporation, a
duly authorized officer of the registrant must
execute the form in Part VII.
Items 13 to 22--Enter the applicable information
for the owner or controlling person. Their home
address and phone number should not be used,
unless a business address and phone number are
unavailable.
Item 23-- Identification information. If you
completed item 22, you may omit this item. If you
did not complete item 22, enter separately the
form of identification, the ID number , and the
issuing state or country . Do not provide “other”
identification unless no driver’s license/state ID,
passport or alien registration number is available.
“Other” identification includes any unexpired official
identification that is issued by a governmental authority.
If you check item 23z, give a brief description of
the “other” identification.
Part IV Money Services and Product
Information
Item 2 4--States and/or territories where the
registrant, its agents or branches are located.
Check box “a” for All States and Territories, “b”
for All States, or “c” for All Territories (Check only
one) as appropriate, and do not check any
individual state or territory boxes. If box a, b, or c
does not apply, check as many state or territory
boxes as necessary . If a service is of fered on
tribal lands, mark the box for the state, territory
or district in which the tribal lands are located.
Item 25--Enter the number of branches of the
registrant. Enter the number of branches of the
money services business at which one or more
MSB activities are offered. If there are no branches,
enter zero. See the General Information for an
explanation of the term “branch”.
Item 26--MSB activities of the registrant. Items
25a through 2 5i are MSB activities. Check t he
box of each MSB activity conducted b y t he
registrant at its branches. See the General
Information for an explanation of the terms “issuer”,
“seller”, “redeemer”, “check casher”, and “money
transmitter”.
Item 27--Informal value transfer system. If any
part of the registrant’s money services business is an
informal value transfer system, check yes. An
informal value transfer system is a kind of money
transmitter. See the General Information
explanation of the term “money transmitter”.
Item 28 --Mobile o peration. If any part of the
registrant’s money services business is conducted
as a mobile operation, check yes. A mobile
operation is one based in a vehicle. For example,
a check cashing service offered from a truck is a
mobile operation. For purposes of Item 25, each
mobile operation should be counted as a separate
branch.
Item 29--Number of agents. Enter the number of
agents that the registrant has authorized to sell or
distribute its MSB services. Do not count branches
or any person who is solely an employee of the
MSB. A bank is not an agent for this purpose. See
the General Information for an explanation of the
term “agent”.
Part V Primary Transaction Account for
MSB Activities
Item 30--Check the box if the registrant has more
than one primary transaction account for money
services business activities. Example: If the
registrant is both an issuer of money orders and an
issuer of traveler’s checks and the registrant has
separate clearing accounts for money orders and
traveler’s checks, the box should be checked.
Item 31--Name of the financial institution where
the primary transaction account is held. Enter
the name of the bank or other financial institution
where the registrant has its primary transaction
account. I f you indicated that the registrant has
more than one primary transaction account in Item
30, enter information about the account with the
greatest money service activity transaction volume
as measured by value in dollars. See the General
Information for an explanation of the term
“transaction account”.
FinCEN Form 107 Registration of Money Services Business Instructions
Items 32 to 35-- Enter the permanent address
for the financial institution.
Item 36--Primary transaction account number.
Enter the primary transaction account number.
Part VI Location of Supporting
Documentation
General: The registrant must retain for five (5)
years certain information at a location within the
United States. That information includes:
1. A copy of the registration form.
2. Annual estimate of the volume of the registrant’s
business in the coming year.
3. The following information regarding ownership
or control of the business: the name and address
of any shareholder holding more than 5% of the
registrant’s stock, any general partner, any trustee,
and/or any director or officer of the business.
4. An agent list.
If the registrant has agents it must prepare and
maintain a list of its agents. That agent list must be
updated annually and retained by the business at
the location in the United States reported on this
registration form in Part II or Part VI. The agent list
should not be filed with this registration form.
The agent list must include:
a. Each agent’s name,
b. Each agent’s address,
c. Each agent’s telephone number,
d. The type of service(s) provided by each agent on
behalf of the registrant,
e. A listing of the months in the immediately
preceding 12 months in which the gross transaction
amount of each agent with respect to financial products/
services issued by the registrant exceeds $100,000,
f. The name and add ress of any depository
institution at which each agent maintains a transaction
account for the money services business activities
conducted by the agent on behalf of the registrant,
g. The year in which each agent first became an
agent of the registrant, and
h. The number of branches or subagents of each
agent.
Items 37 to 40--If the supporting documentation
is retained at a location other than the address
listed in Part II, enter the location information in
items 37 through 40.
Part VII Authorized Signature
Items 41 to 44--The owner or controlling person
listed in Part III must sign and date the form as
indicated in Part VII. If the owner or controlling
person is a corporation, a duly authorized officer
of the corporation must execute the form on behalf
of the corporation. Enter the date this document
was signed.
Penalties for failure to comply: Any person who
fails to comply with the requirements to register,
keep records, and/or maintain agent lists
pursuant to 31 CFR 10 22.380 may be liable for
civil penalties of up to $5,000 for each violation.
Failure to comply also may subject a person to
3
criminal penalties, which may include
imprisonment for up to five (5) years and criminal
fines. See 18 USC 1960. Note: This registration
does not satisfy any state or local licensing or
registration requirement s.
Paperwork Reduction Act Notice.
The purposes of this form are to provide an effec-
tive and consistent means for money services busi-
nesses to register with the Financial Crimes En-
forcement Network, and to assure maintenance of
reports or records where such reports or records
have a high degree of usefulness in criminal, tax,
or regulatory investigations or proceedings. This
report is required by law , pursuant to authority
contained in Public Law 103-305; 31 USC 5330; 5
USC 301; 31 CFR Chapter X. The information
collected may be provided to those officers and
employees of any constituent unit of the Depart-
ment of the Treasury who have a need for the
records in the performance of their duties. The
records may be referred to any other depart-
ment or agency of the United States, to any State,
or Tribal Government. Public reporting and re-
cordkeeping burden for this information collec-
tion is estimated to average 30 minutes per re-
sponse, and includes time to gather and maintain
data for the required report, review the instruc-
tions, and complete the information collection.
Send comments regarding this burden estimate,
including suggestions for reducing the burden,
to the Office of Management and Budget Paper-
work Reduction Project, Washington, DC 20503
and to the Paperwork Reduction Act; Department
of the Treasury, Financial Crimes Enforcement
Network, P.O. Box 39 , V ienna, VA 22183-0039.
The agency may not conduct or sponsor , and an
organization (or a person) is not required to re-
spond to, a collection of information unless it dis-
plays a currently valid OMB control number .
Privary Act Notice.
Pursuant to the requirements of Public Law 93-
579 (Privacy Act of 1974), notice is hereby given
that, in accordance with 5 U.S.C. 552a(e), the au-
thority to collect information on FinCEN Form 107
is Public Law 103-305; 31 USC 5330; 5 USC 301;
31 CFR Chapter X. The Department of the Trea-
sury may use and share the information with any
other department or agency of the United States,
to any State, or Tribal Government, or part thereof,
upon the request of the head of such department
or agency, or authorized S tate or Tribal Govern-
ment official for use in a criminal, tax, or regula-
tory investigation or proceeding, and to foreign
governments in accordance with an agreement, or
a treaty.
Disclosure of this information is mandatory. Civil
and criminal penalties, including in certain cir-
cumstances a fine of not more than $5,000 per
day and imprisonment of not more than five years,
are provided for failure to file the form, supply
information requested by the form, and for filing a
false or fraudulent form. Disclosure of the social
security number or taxpayer identification number
is mandatory. The authority to collect is 31 CFR
Chapter X. The social security number/taxpayer
identification number will be used as a means to
identify the individual or entity who files the re-
port.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Registration of Money FinCEN Form 107 Services Business (IRS)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 24 November 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document