Court filing

Exhibit 104 — USA v. Crowther (Dkt. 136.82)

Summary

An Account Agreement from Sanibel Captiva Community Bank dated 04/10/2020, filed 03/31/21 in Case 2:20-cr-00114-JES-M_M as Document 136-82 (exhibit tag EX_104_001). The account owner is Target Roofing and Sheet Metal Inc., a corporation whose business is listed as roofing contractor. The account description reads PPP LOAN, and the source of the initial deposit is printed as LN PROCEEDS. The backup withholding certification names Casey D Crowther.

Summary drafted by a model from the document's text below and checked by script against that text before publication. It is a navigation aid, not a reading of what the document proves. Where AI is used

Filed March 31, 2021 in USA v. Crowther; one of 365 filings from this case.

Record facts

Court	U.S. District Court for the Middle District of Florida
Filed	2021-03-31

Cite this document

“Exhibit 104 — USA v. Crowther (Dkt. 136.82).” U.S. District Court for the Middle District of Florida, No. 2:20-cr-00114, Doc. 136-82, filed 2021-03-31. Archived at Pandemic Darlings, https://pandemicdarlings.com/court-filings/full-docket-casey-david-crowther-flmd-381779/2021-03-31-gov-uscourts-flmd-381779-136-82-doc-136-82/, SHA-256 f334f67592af766edafe03afb74312c23ba5f2e75b68cedcf1f0b5bafa0a96fb.

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Full text

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Case 2:20-cr-00114-JES-M_M Document 136-82
2613

ACCOUNT AGREEMENT

Filed 03/31/21 Page 1 of 1 PagelD”

SANIBEL CAPTIVA COMMUNITY BANK
1533 HENDRY STREET SUITE 100
FORT MYERS FL 33901

Account 29086781
Number:

Agreement Date: __04/10/2020__ By: Kristin Dilorio

1 EXISTING Account - This agreement replaces previous agreement(s).
Account Description: PPP LOAN

& Checking 0 Savings CF] Now 1)

Initial Deposit $ 1.480,722.00 Source: LN PROCEEDS

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

1841 ORTIZ AVE

FORT MYERS FL_33905

Ownership of Account - CONSUMER (Select One and Inittal)

0) Single-Pany Account 2 Trust-Separate Agreement
() Multiple-Party Account
(1 Multiple-Party Account - Tenancy by the Enlireties
O) other

Rights at Death (Select One and Initlal)

Single-Party Account

Multiple-Party Account With Right of Survivorship
Multipte-Party Account Wilhout Right of Survivorship
Single-Party Account With Pay On Death

Multipte-Party Account With Right of Survivership
and Pay On Death
Pay-On-Death Beneficiaries, To Add Pay-On-Death Beneficiaries Name One or More:

oo0000n0

The undersigned also

Additional Information:

Signaturo(s). The undersigned certifies the accuracy of the Infermatton hafshe has
provided end acknowledges receipt of s completed copy of this form. The undersigned

authorizes the financial Institutlon to verify credit and employment history and/or have

a credit raperting a fy a credit report on the unders! as Individuals,
oon asacknow ledge tho receipt ola copy and agzoe tothe terms of tre
fotlowing agreament(s) and/or disctosure{s):

& Terms & Conditions Truth in Savings B) Funds Avallebility

Bectronic Fund Transfers (& Privacy Substitute Checks

O Common Festures ©

Tha Internal Revenue Service does not require your consent to eny

provision of this document other thanthe certifications required to
avoid backup withholding. 4

Ownership of Account - BUSINESS Purpose

{] Sole Proprietorship 1) Single-Member LLC () Partnership
3 ULC (tLCtax classification: 0 Ccop 0 scop OO Pannersnip)
(2 CCorporation OO S Corporation OD Nen-rorit
CORPORATION

Business: ROOFING CONTRACTOR

Backup Withholding Certifications (Non-°U S. Persons’ - Use separate Form W8)
By signing at right, i, CASEY D CROWTHER
cerlily under penalties of perjury that (he stalemenis made in this section are true.

TIN: 47-4767499 The Taxpayer Identification
Number (TIN) show a is my correct taxpayer identification number.

Not Subject to Backup Withholding. | am NOT subject to backup
withholding either because | have not been notified that | em subject to backup

withholding as a resuit of a failure to report all interes! or dividends, or the Interna!
Revenue Service has notified me that | am no longer subject to backup withholding.

(J Exempt Recipient. | am an exempt recipient under {he Internal Revenue
Service Regulations. Exempt payee code (if any)

FATCA Code. The FATCA code entered on this form (if any) indicating that | em
exempt from FATCA reporting fs correct.

U.S. Person. ! am a U.S. citizan or other U.S. person (as defined
In the Instructions).

CA [>] ER

1.0. # C636-104-85-322-0 0.0.8. 09/02/1985
(2). Ix ]
LD. # 0.0.8.
al
(3) x ]
_
LO. # 0.0.8
e
(4). 9x
-:
.D. # D.O.8.
© Convenience Account Agent (Single-Party Accounts Only)

1.0. # 0.0.8.

OdTHZOZO

Signature Card-FL
Bankers Systems™ YMPO
Wolters Kluwer Financia! Services ©2016

EX_104_001

bd

File and source

File: gov.uscourts.flmd.381779.136.82.pdf
Size: 92,323 bytes
SHA-256: f334f67592af766edafe03afb74312c23ba5f2e75b68cedcf1f0b5bafa0a96fb
Our copy: gov.uscourts.flmd.381779.136.82.pdf
Original: PACER (login required)