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Get FinCEN 104 2011-2023

11 ZIP code a / / MM DD YYYY 13 Occupation, profession, or business 12 Country code (if not U.S.) b Driver s license/State I.D. Passport e Issued by: c f Alien registration Number: Section B--Individual(s) Conducting Transaction(s) (if other than above). 15 Individual s last name 19 SSN 18 Address (number, street, and apt. or suite no.) 20 City 21 State 25 If an individual, describe method used to verify identity: d Part I Other 17 Middle initial 16 First name.

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