Currency Transaction Report

1. Financial Institution Information

Institution Name: Vyceri Bank

Institution Address: 1234 Financial Avenue, Metropolis, USA

EIN: XX-XXXXXXX

Contact Person: Sarah Williams, Compliance Officer

Phone Number: (555) 987-6543

Name: Robert Miller

Address: 4567 Oak Street, Metropolis, USA

Date of Birth: March 5, 1978

Identification Type: Driver's License

Identification Number: D1234567

Issuing State: Metropolis

Occupation: Construction Contractor

Account Number(s): 1122334455

Date of Transaction: October 19, 2023

Total Cash In Amount: $12,500

Total Cash Out Amount: $0

Transaction Type(s): Cash Deposit

Currency Details:

Denomination	Count	Total Amount
$100 Bills	125	$12,500

Branch Location: Downtown Branch, 789 Main Street, Metropolis, USA

The following documents are attached to this report:

I certify that the information provided above is true and correct to the best of my knowledge.

Name: Sarah Williams

Title: Compliance Officer

Signature: _________________________

Date: October 20, 2023