Exhibit 99 — USA v. Crowther (Dkt. 136.77)

Record facts

U.S. District Court for the Middle District of Florida · No. 2:20-cr-00114 · Doc. 136-77 · 2021-03-31 · Docket on CourtListener

Full text

Case 2:20-cr-00114-JES-M_M Document 136-77

Filed 03/31/21 Page1of1PRagelnh:

2597

ACCOUNT AGREEMENT

SANIBEL CAPTIVA COMMUNITY BANK —
7500 COLLEGE PKWY
FORT MYERS, FL. 33907

‘Account 29086331
Number:

Agreement Date: 04/07/2020 . By: Diane Jefferson
EK] EXISTING Account - This agreement replaces previous ‘egreement(s).
Account Description: OPERATING

Ql Checking C Savings D Now 0

Account Owner(s) Name & Address —
TARGET ROOFING AND SHEET METAL INC

1841 ORTIZ AVE
Initial Deposit § 93,100.00 Source: TRANSFER FORT MYERS FL 33905
_ Ownership of Account - CONSUMER (Select One and Initial) Additional Information:
0 singte-Party Account (2 Trust-Separate Agreement __

- C2 Muttipte-Party Account
‘(0 Multipte-Party Account - Tenancy by the Enthreties
OO cxher

Rights at Death (Select One and Initial)

DO singte-Party Account

OC Multipie-Party Account With Right of Survivorship
0 Muttipte-Party Account Without Right of Survivorship
0 Singte-Party Account With Pay On Death
 Muttipie-Psrty Account With Right of Survivorship

and Pay On Death
Pay-On-Death Genofictaries. To Add Pay-On-Ceath Beneficiaries Nama One or Mora:

" Ownership of Account - BUSINESS Purpose

'( Sole Proprietorship  SingleMember LLC (1 Partnership
‘DO UC ¢ttctax efassitication: CF] coop 0 scop LC Partnership)
0 C Corporation 0 5 Corporation 0 Non-Profit
(2 CORPORATION __ _ ;
Susiness: ROOFING COMPANY oo, ; oo.

Beck Withholding Certifications (Nor"U.S. Persons” - Use separate Form W3)
BS Bsirepa it, | CASEY D GROWTH
penalties of perjury thal Ehestatema

a TIN: 47-4767409

Number (TIN) shown Is my correct taxpayer Kderdlcation number,

8 Not Subject to Backup tit : ban tobackup
withholding either becatise | havé pik Beery notte (7 crab be

waNOtarG os areal of atabarlon reer altaaea ecaniaet oui

Revenue Service has notified ma thal I'am no tonger subject Lo backup wilh

© Exempt Reeiptent. | em an exempt recipient under the internal Revenue

Service Reguisttons, Exempt payee code (if eny) .

FATCA Code, The FATCA code entered on this form (Hany) indicating that lem

exempt from FATCA reporting Is correct,

U.S. Person. am a U.S. citizen or other U.S. person (2s defined

made ii this caction are cus,
‘Te Taxpayer Wdentfication

in tho instructions).

Wana Rober Fined Services ©2016

&) Terms & Conditions &) Truth in Savings I Funds Availability
® Bectronic Fund Transfers [l Privacy [4 Substitute Checks

= comme Features O

intemal Revenue Service does not our consent t
prodsin of of neta? tnt er thar  fequire your cor roguired {0
(1): f. =e ]
CASEY D CROWTHER

LD, # C636-104-35-322-0.. 0.0.2. 09/02/1985

1D. # . D.O.B.

LD. # D.OB

LD, # D.O.B
© Convertence Account Agent (Single-Party Accounts Only)

[. ]

LD. # : 0.0.B

EX_99 001

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