Exhibit 68 — USA v. Crowther (Dkt. 136.46)

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Case 2:20-cr-00114-JES-M_M Document 136-46 Filed 03/31/21 Page 1 of 3 PageID
1999
[logo: Sanibel Captiva COMMUNITY BANK]
Certification of Beneficial Owners of Legal Entities
Financial Institution Name: SANIBEL CAPTIVA COMMUNITY BANK
Financial Institution Location: 2475 LIBRARY WAY SANIBEL, FL 33957
Financial Institution Contact Person: Kyle DeCicco
Contact Phone Number: (239) 472-6100
Customer Portfolio/Identifier: [handwritten: 1070250]
I. GENERAL INSTRUCTIONS
What is this form?
To help the government fight financial crime, Federal regulation requires certain financial institutions to obtain, verify, and record information about the beneficial owners of legal entity customers. Legal entities can be abused to disguise involvement in terrorist financing, money laundering, tax evasion, corruption, fraud, and other financial crimes. Requiring the disclosure of key individuals who own or control a legal entity (i.e., the beneficial owners) helps law enforcement investigate and prosecute these crimes.
Who has to complete this form?
This form must be completed by the person opening a new account on behalf of a legal entity with any of the following U.S. financial institutions: (i) a bank or credit union; (ii) a broker or dealer in securities; (iii) a mutual fund; (iv) a futures commission merchant; or (v) an introducing broker in commodities.
For the purposes of this form, a legal entity includes a corporation, limited liability company, or other entity that is created by a filing of a public document with a Secretary of State or similar office, a general partnership, and any similar business entity formed in the United States or a foreign country. Legal entity does not include sole proprietorships, unincorporated associations, or natural persons opening accounts on their own behalf.
What information do I have to provide?
This form requires you to provide the name, address, date of birth and Social Security number (or passport number or other similar information, in the case of Non-US Persons) for the following individuals (i.e., the beneficial owners):
(i) Each individual, if any, who owns, directly or indirectly, 25 percent or more of the equity interests of the legal entity customer (e.g., each natural person that owns 25 percent or more of the shares of a corporation); and
(ii) An individual with significant responsibility for managing the legal entity customer (e.g., a Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, Managing Member, General Partner, President, Vice President, or Treasurer).
The number of individuals that satisfy this definition of "beneficial owner" may vary. Under section (i), depending on the factual circumstances, up to four individuals (but as few as zero) may need to be identified. Regardless of the number of individuals identified under section (i), you must provide the identifying information of one individual under section (ii). It is possible that in some circumstances the same individual might be identified under both sections (e.g., the President of Acme, Inc. who also holds a 30% equity interest). Thus, a completed form will contain the identifying information of at least one individual (under section (ii)), and up to five individuals (i.e., one individual under section (ii) and four 25 percent equity holders under section (i)).
The financial institution may also ask to see a copy of a driver's license or other identifying document for each beneficial owner listed on this form.
EX_68_001
Case 2:20-cr-00114-JES-M_M Document 136-46 Filed 03/31/21 Page 2 of 3 PageID
2000
II. CERTIFICATION OF BENEFICIAL OWNER(S)
Persons opening an account on behalf of a legal entity must provide the following information:
Name of Natural Person Opening Account: Casey Crowther
Title of Natural Person Opening Account: President
Name and Type of Legal Entity for Which the Account is Being Opened: Target Roofing and Sheet Metal Inc
Physical Address of Legal Entity for Which the Account is Being Opened: 1841 Ortiz Ave Fort Myers, Fl 33905
Provide the following information for each individual, if any, who, directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, owns 25 percent or more of the equity interests of the legal entity listed above:
Name Date of Birth Address (Residential or Business Street Address) For U.S. Persons: Social Security Number For Non-US Persons: SSN, Passport Number and Country of Issuance, or other similar identification number
First Casey Last Crowther % Ownership (100) 09/02/1985 Street 6551 Nalle Grade Rd City North Fort Myers State & Zip Fl 33917 593-88-8937 Number Country of Issuance
First Last % Ownership ( ) Street City State & Zip Number Country of Issuance
First Last % Ownership ( ) Street City State & Zip Number Country of Issuance
First Last % Ownership ( ) Street City State & Zip Number Country of Issuance
( ) If checked, Beneficial Owner listing requirement is Not Applicable.
EX_68_002
Case 2:20-cr-00114-JES-M_M Document 136-46 Filed 03/31/21 Page 3 of 3 PageID
2001
Provide the following [illegible] for one individual with [illegible] responsibility for [illegible] the legal [illegible] listed above, such as:
An executive officer or senior manager (e.g., Chief Executive Officer, Chief Financial [illegible], Chief Operating Officer, Managing Member, General [illegible], President, Vice President, [illegible]); or
Any other individual who [illegible] [illegible] similar functions.
(If appropriate, an individual listed under the ownership section above may also be listed in the section below).
Name/Title Date of Birth Address (Residential or Business Street Address) For U.S. Persons: Social Security Number For Non-US Persons: SSN, Passport Number, and country of issuance, or other similar identification number
First Casey Last Crowther Title President [illegible]02/1985 Street [illegible] Nalle [illegible] Rd City [illegible] Myers, State & Zip [illegible] [illegible] [label illegible] [label illegible]
I, Casey Crowther [label illegible] hereby certify, to the best of my knowledge, that the information provided above is complete and correct.
Signature: [signature] Date: [illegible]
For Institution Use Only:
Type of Document Document ID Number Place of Issuance Date of Issuance Expiration Date
Owner 1, Casey [label illegible] [illegible] Florida 09/20/1[illegible] 09/02/27
Owner 2 [label illegible]
Owner 3 [label illegible]
Owner 4 [label illegible]
Control Casey [label illegible] [illegible] Florida 09/20/19 0[illegible]/02/27
EX_68_003


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