Part II Registrant Information - IRS Tax Forms

Rev. 7/10FinCEN Form 107aGeneral InformationRegistration of Money Services Business InstructionsWho Must RegisterGenerally each money services business mustregister with the Department of the Treasury. Thisform 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 agentof another MSB, you are not required to register.The discussion below will help you determinewhether or not you are an MSB that is required toregister. For more information visitwww.msb.gov.The term money services business includes:1. Currency dealers or exchangers who exchangemore than 1,000 for any one customer on anyday.2. Check cashers who cash checks totaling morethan 1,000 for any one customer on any day.3. Issuers of traveler’s checks, money orders orstored value who issue more than 1,000 intraveler’s checks, money orders or stored valuefor any one customer on any day.4. Sellers of traveler’s checks, money orders orstored value who sell more than 1,000 in traveler’schecks, money orders or stored value for any onecustomer on any day.5. Redeemers of traveler’s checks, money ordersor stored value who redeem more than 1,000 intraveler’s checks, money orders or stored valuefor 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 servesas an agent of another MSB. For example, asupermarket corporation that sells money ordersfor an issuer of money orders is not required toregister. This is true even if the supermarketcorporation serves as an agent for two or moreMSBs. However, an MSB that serves as an agent ofanother MSB and engages in MSB activities on itsown behalf must register . For example, asupermarket corporation must register if, in additionto acting as an agent of the money order issuer, itprovides check cashing or currency exchangeservices on its own behalf in an amount greaterthan 1,000 for any one person on any day.2. The United States Postal Service, any agency ofthe United States, of any state, or of any politicalsubdivision of any state.3. At this time, persons are not required to registerto the extent that they issue, sell or redeem storedvalue. If, however , a money services businessprovides money services in addition to storedvalue, the provision of stored value services doesnot relieve it of the responsibility to register , ifrequired, as a provider of those other services.For the regulatory definition of “money servicesbusiness” see 31 CFR 1010.100(t) and (ff).19. A “redeemer” is a business that acceptsinstruments in exchange for currency or otherinstruments for which it is not the issuer. You arenot a redeemer if you take the instruments inexchange for goods or general services, providedthat the amount of cash returned is not more than 1,000 for any one customer on any day.The following terms are used in the form andinstructions to describe a money services business:10. A “seller” is a business that issuers authorize,through written agreement or otherwise, to sell1. An “agent” is a separate business entity from the their instruments or their send and receive transferservices.issuer that the issuer authorizes, through writtenagreement or otherwise, to sell its instruments or,in the case of funds transmission, to sell its send 11. A “transaction account” is a deposit or accounton which the depositor or account holder isand receive transfer services. A person who issolely an employee of the MSB is not an agent of permitted to make withdrawals by negotiable ortransferable instrument, payment orders ofthat MSB.withdrawal, telephone transfers, or other similar itemsfor the purpose of making payments or transfers to2. A “branch” is an owned location of either anissuer or agent at which financial services are sold. third persons or others. Such terms include demandAn MSB should not separately register each of its deposits, negotiable order of withdrawal accounts,branches. A mobile operation owned by an MSB is savings deposit subject to automatic transfers, anda branch of that MSB. The MSB’s headquarters is share draft accounts. See 12 USC 461(b)(1)(c).not a branch. If the MSB has only one location,When to Registerthat location is not a branch.Initial registration: File the form within 180 days3. A “check casher” is a person engaged in thebusiness of providing cash to persons in return for after the date the business is established.a check.Renewal: Each MSB must renew its registrationevery two years, on or before December 31. See4. A “currency dealer or exchanger” is a personwho engages in the physical exchange of currency 31 CFR 1022.380(b)(2). For example, if an MSBregistered on October 15, 2003, it must file afor retail customers.renewal by December 31, 2004, and then every5. “Informal value transfer system”. See explanation 24 months thereafter (on or before December 31,2006, then December 31, 2008, etc.). Renewalsof the term money transmitter.must be submitted on a new Form 107. Photocopies of previously submitted forms or6. An “issuer” is the business that is ultimatelyfacsimiles will not be accepted for renewalresponsible for payment of money orders ortravelers checks as the drawer of such instruments, purposesor a money transmitter that has the obligation toCorrection: Use the form to correct a prior report.guarantee payment of a money transfer.Complete Part I in its entirety and only those other7. A “money transmitter” is a person that engages entries that are being added or changed. Staple acopy of the prior report (or the acknowledgmentas a business in the transfer of funds through afrom ECC-D if received) to the corrected report.financial institution.Generally, acceptance and transmission of funds asan integral part of the execution and settlement of Re-registration: Refile a new registration forma transaction other than the funds transmission itself when one of the following events occurs:1. a change in ownership requiring re-registration(for example, in connection with the bona fideunder state registration law;sale of securities) will not cause a person to be a2. more than 10 percent of voting power or equitymoney transmitter.interest is transferred (except certain publiclyAn “informal value transfer system” is a kind oftraded companies) or;money transmitter . An informal value transfer3. the number of agents increases by more than 50system includes any person who engages as apercent.business in an informal money transfer system orany network of people who engage as a business infacilitating the transfer of money domestically orWhere to Registerinternationally outside of the conventional financial Send your completed form to:institutions system.8. A “person” is an individual, a corporation, aEnterprise Computing Center - Detroitpartnership, a trust or estate, a joint stock company,Attn: Money Services Business Registrationan association, a syndicate, joint venture, or other P.O. Box 33116unincorporated organization or group, an IndianDetroit, MI 48232-0116Tribe (as that term is defined in the Indian GamingRegulatory Act), and all entities cognizable as legalpersonalities.

FinCEN Form 107Registration of Money Services Business Instructions2Part III Owner or Controlling PersonThe Enterprise Computing Center-Detroit (ECCD) will send an acknowledgment of receipt to theregistrant listed in Part II within approximately 60days after the form is processed (See note below).ECC-D can respond to general questions over thephone at telephone (800) 800-2877.entity. A post of fice box number should not beused for an individual, unless no other address isavailable. For an individual, also enter anyapartmentnumber, suite number, or road or route number. Ifa P.O. Box is used for an entity , enter the streetname, suite number, and road or route number.If the address of the individual or entity in PARTIII is in a foreign country, enter the city, provinceor 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 theaddress is in the United States leave country codeblank.11. Addresses: Enter the US permanent streetaddress, city , two-letter st ate or territoryabbreviation used by the U.S. Postal Service andZIP Code (ZIP 4 if known) of the individual orItem 11-- E-mail address (Optional). If the MSBhas an e-mail address please enter it here. An e- Item 2 4--States and/or territories where themail address may be used to contact the MSB should registrant, its agents or branches are located.Check box “a” for All States and Territories, “b”questions arise regarding their registration.for All States, or “c” for All Territories (Check onlyGeneral: Any person who owns or controls amoney services business is responsible forregistering the MSB. Only one registration form isrequired for any business in any registration period.If more than one person owns or controls thebusiness, they may enter into an agreementGeneral Instructionsdesignating one of them to register the business.The designated owner or controlling person mustNOTE: All items on FinCEN Form 107 should becomplete Part III and provide the requestedcompleted fully and accurately. Items markedinformation. In addition, that person must sign andwith an asterisk (*)must be completed for thedate the form as indicated in Part VII. Failure byregistration to be accepted, processed, andthe designated person to register the business doesrecorded. Acknowledgment letters will not benot relieve any other person who owns or controlsprovided if these items are not complete.Specific Instructionsthe business of the liability for failure to registerthe business.Part I Filing Information1. This form is available on the Financial CrimesSee “When to Register” in the General Information An “Owner or Controlling Person” includes theEnforcement Network’s web site for MSBs atfollowing:part of these instructions.www.msb.gov, or FinCEN’ s web site atRegistrant BusinessOwner orwww.fincen.gov, or by calling the IRS FormsControlling PersonItem 1-- Check either box a, b, or d (only one) forDistribution Center at (800) 829-3676.Sole Proprietorship. the individual whothe type of filing. If this report correct s an earlierowns the businessfiling, check box “c” and either box a, b, or d.2. Unless there is a specific instruction to thePartnership.a general partnercontrary, leave blank any items that do not apply orTrust. a trusteeItem 2-- If you checked box 1d, please indicatefor which information is not available.the reason by checking boxes a, b, or c (check all Corporation.the largest singleshareholderthat apply).3. Complete the form by providing as muchIf two or more persons own equal numbers ofinformation as possible.shares of a corporation, those persons may enterPart II Registrant Information4. Do not include supporting documents with this Enter the US State or Territory operating location. into an agreement as explained above that one ofthose persons may register the business.form.If the owner or controlling person is a corporation, aItem *3--Legal name of the money servicesbusiness. Enter the full legal name of the registrant duly authorized officer of the owner-corporation may5. Type or complete the form using block writtenmoney services business as it is shown on the charter execute the form on behalf of the owner-corporation.letters.or other document creating the entity. For example,enter Good Hope Enterprises, Inc. when the money Item 12--Individual’s last name, or organization’s6. Enter all dates in MM / DD / YYYY formatname. If the registrant is a publicly held corporation,where MM month, DD day , and YYYY year. services business is Good Hope Enterprises, Inc.If ait is sufficient to write “public corporation” in itemPrecede any single number with a zero,i.e., 01,02, sole proprietorship, enter the business name of12. Where registrant is a public corporation, athe proprietorship.etc.duly authorized officer of the registrant must7. List all U.S. telephone numbers with area code Item 4-- Doing business as. If applicable, enter the execute the form in Part VII.first and then the seven-digit phone number , separate doing business as name of the registrant. ForItems 13 to 22--Enter the applicable informationexample, if Good Hope Enterprises, Inc., i s doingusing the format (XXX) XXX-XXXX.business as “Joe’s Check Cashing” enter in item 4, for the owner or controlling person. Their homeaddress and phone number should not be used,8. Always enter an individual’s name as last name, Joe’s Check Cashing.unless a business address and phone number arefirst name, and middle initial (if known). If a legalunavailable.Items *5, *6, *7 and 8-- Address.Enter theentity is listed, enter its name in the last namepermanent United States address of the registrant’sfield.Item 23-- Identification information. If youUS operations that is being registered.completed item 22, you may omit this item. If you9. Enter identifying numbers starting from left toItem *9-- EIN (entity), SSN/ITIN (individual). If did not complete item 22, enter separately theright. Do not include spaces, dashes, or otherform of identification, the ID number , and thethe registrant is an entity enter its employerpunctuation. Identifying numbers include socialidentification number (EIN). If the registrant is an issuing state or country . Do not provide “other”security number (SSN), employer identificationidentification unless no driver’s license/state ID,individual and a U. S. Citizen or an alien with anumber (EIN), individual taxpayer identificationpassport or alien registration number is available.number (ITIN), alien registration number, driver’s social security number, enter his/her SSN. If theregistrant is an individual who is an alien and has “Other” identification includes any unexpired officiallicense/state identification, foreign nationalan individual taxpayer identification number, enter identification that is issued by a governmental authority.identification, and passport number.If you check item 23z, give a brief description ofhis/her ITIN.the “other” identification.10. Enter all Post Office ZIP Codes from left toright with at least the first five numbers, or with all Item 10-- Telephone number. Enter the telephonePart IV Money Services and Productnumber of the MSB listed in item 3.nine (ZIP 4) if known.Information

FinCEN Form 107Registration of Money Services Business Instructionsone) as appropriate, and do not check anyindividual state or territory boxes. If box a, b, or cdoes not apply, check as many state or territoryboxes as necessary . If a service is of fered ontribal lands, mark the box for the state, territoryor district in which the tribal lands are located.Item 25--Enter the number of branches of theregistrant. Enter the number of branches of themoney services business at which one or moreMSB activities are offered. If there are no branches,enter zero. See the General Information for anexplanation of the term “branch”.Items 32 to 35-- Enter the permanent addressfor the financial institution.Item 36--Primary transaction account number.Enter the primary transaction account number.Part VI Location of SupportingDocumentationGeneral: The registrant must retain for five (5)years certain information at a location within theUnited States. That information includes:1. A copy of the registration form.2. Annual estimate of the volume of the registrant’sItem 26--MSB activities of theregistrant. Items business in the coming year.3. The following information regarding ownership25a through 2 5i are MSB activities. Check t heor control of the business: the name and addressbox of each MSB activity conducted b y t heof any shareholder holding more than 5% of theregistrant at its branches. See the GeneralInformation for an explanation of the terms “issuer”, registrant’s stock, any general partner, any trustee,and/or any director or officer of the business.“seller”, “redeemer”, “check casher”, and “money4. An agent list.transmitter”.If the registrant has agents it must prepare andmaintain a list of its agents. That agent list must beItem 27--Informal value transfer system. If anypart of theregistrant’s money services business is an updated annually and retained by the business atthe location in the United States reported on thisinformal value transfer system, check yes. Aninformal value transfer system is a kind of money registration form in Part II or Part VI.The agent listshould not be filed with this registration form.transmitter. See the General InformationThe agent list must include:explanation of the term “money transmitter”.a. Each agent’s name,b. Each agent’s address,Item 28 --Mobile o peration. If any part of thec. Each agent’s telephone number,registrant’s money services business is conductedd. The type of service(s) provided by each agent onas a mobile operation, check yes. A mobileoperation is one based in a vehicle. For example, behalf of the registrant,e. A listing of the months in the immediatelya check cashing service offered from a truck is apreceding 12 months in which the gross transactionmobile operation. For purposes of Item 25, eachmobile operation should be counted as a separate amount of each agent with respect to financial products/services issued by theregistrant exceeds 100,000,branch.f. The name and add ress of any depositoryItem 29--Number of agents. Enter the number of institution at which each agent maintains a transactionagents that the registrant has authorized to sell or account for the money services business activitiesdistribute its MSB services. Do not count branches conducted by the agent on behalf of theregistrant,g. The year in which each agent first became anor any person who is solely an employee of theMSB. A bank is not an agent for this purpose. See agent of theregistrant, andh. The number of branches or subagents of eachthe General Information for an explanation of theagent.term “agent”.Part V Primary Transaction Account forMSB ActivitiesItem 30--Check the box if the registrant has morethan one primary transaction account for moneyservices business activities. Example: If theregistrant is both an issuer of money orders and anissuer of traveler’s checks and the registrant hasseparate clearing accounts for money orders andtraveler’s checks, the box should be checked.Item 31--Name of the financial institution wherethe primary transaction account is held. Enterthe name of the bank or other financial institutionwhere the registrant has its primary transactionaccount. I f you indicated that the registrant hasmore than one primary transaction account in Item30, enter information about the account with thegreatest money service activity transaction volumeas measured by value in dollars. See the GeneralInformation for an explanation of the term“transaction account”.Items 37 to 40--If the supporting documentationis retained at a location other than the addresslisted in Part II, enter the location information initems 37 through 40.Part VII Authorized SignatureItems 41 to 44--The owner or controlling personlisted in Part III must sign and date the form asindicated in Part VII. If the owner or controllingperson is a corporation, a duly authorized officerof the corporation must execute the form on behalfof the corporation. Enter the date this documentwas signed.Penalties for failure to comply: Any person whofails to comply with the requirements to register,keep records, and/or maintain agent listspursuant to 31 CFR 10 22.380 may be liable forcivil penalties of up to 5,000 for each violation.Failure to comply also may subject a person to3criminal penalties,which mayincludeimprisonment for up to five (5) years and criminalfines. See 18 USC 1960. Note: This registrationdoes not satisfy any state or local licensing orregistration requirement s.Paperwork Reduction Act Notice.The purposes of this form are to provide an effective and consistent means for money services businesses to register with the Financial Crimes Enforcement Network, and to assure maintenance ofreports or records where such reports or recordshave a high degree of usefulness in criminal, tax,or regulatory investigations or proceedings. Thisreport is required by law , pursuant to authoritycontained in Public Law 103-305; 31 USC 5330; 5USC 301; 31 CFR Chapter X. The informationcollected may be provided to those officers andemployees of any constituent unit of the Department of the Treasury who have a need for therecords in the performance of their duties. Therecords may be referred to any other department or agency of the United States, to any State,or Tribal Government. Public reporting and recordkeeping burden for this information collection is estimated to average 30 minutes per response, and includes time to gather and maintaindata for the required report, review the instructions, and complete the information collection.Send comments regarding this burden estimate,including suggestions for reducing the burden,to the Office of Management and Budget Paperwork Reduction Project, Washington, DC 20503and to the Paperwork Reduction Act; Departmentof the Treasury, Financial Crimes EnforcementNetwork, P.O. Box 39 , V ienna, VA 22183-0039.The agency may not conduct or sponsor , and anorganization (or a person) is not required to respond to, a collection of information unless it displays a currently valid OMB control number .Privary Act Notice.Pursuant to the requirements of Public Law 93579 (Privacy Act of 1974), notice is hereby giventhat, in accordance with 5 U.S.C. 552a(e), the authority to collect information on FinCEN Form 107is Public Law 103-305; 31 USC 5330; 5 USC 301;31 CFR Chapter X. The Department of the Treasury may use and share the information with anyother department or agency of the United States,to any State, or Tribal Government, or part thereof,upon the request of the head of such departmentor agency, or authorized S tate or Tribal Government official for use in a criminal, tax, or regulatory investigation or proceeding, and to foreigngovernments in accordance with an agreement, ora treaty.Disclosure of this information is mandatory. Civiland criminal penalties, including in certain circumstances a fine of not more than 5,000 perday and imprisonment of not more than five years,are provided for failure to file the form, supplyinformation requested by the form, and for filing afalse or fraudulent form. Disclosure of the socialsecurity number or taxpayer identification numberis mandatory. The authority to collect is 31 CFRChapter X. The social security number/taxpayeridentification number will be used as a means toidentify the individual or entity who files the report.

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 n