Exhibit 106 — USA v. Crowther (Dkt. 136.84)

Summary

A bank form filed March 31, 2021 as Doc. 136-84, Exhibit 106 in USA v. Crowther, No. 2:20-cr-00114, in the U.S. District Court for the Middle District of Florida. The form gives the account type as Corporation and the purpose of the account as PAYROLL, with Expected ACH Activity NONE and Expected Wire Activity NONE. Its business section lists Target Roofing, a ROOFING COMPANY registered in Lee County Florida with a LOCAL primary trade area. The owner section names Casey D Crowther with the occupation OWNER OF ROOFING CO and the employer Target Roofing.

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Case 2:20-cr-00114-JES-M_M Document 136-84 Filed 03/31/21 Page1ofiPagelb =

COMMUNITY BANK

Opened By KRISTIN DIIORIO BUSINESS NEW ACCOUNT SCORECARD
5] Date Opened 04/10/2020. Account # Source of Deposits INTERNAL TRANSFER
5 Initial Deposit 1.480,722.00 =» Account Type Corporation ._—~—~—s» Purpose of this Acct PAYROLL
g Expected Avg Monthly Balance 50,001 + Expected ACH Activity NONE
Expected Wire Activity NONE. Monthly ACH Amount $0 - $10,000
Monthly Wire Frequency NONE Monthly Cash In/Out Amount $0-$500
Monthly Wire Amount $0 - $10,000 Monthly Cash In/Out Frequency LESS THAN 5
Z| Business Name TARGET ROOFING AND SHEET METALINC New or existing customer? Is there a store front?
=
2 Tax ID 47-4767409 [] New [x] Yes
w] Physical Address 1841 ORTIZ AVE x] - C]
wy FORTMYERS _FL_33905 Existing No
B State Where Registered LEE COUNTY FLORIDA Internet Gambling Business?
@! Description of Business | ROOFING COMPANY [_] ves ityes, D0 NOT OPEN.
Primary Trade Area LOCAL. [x] No
Own/Maintain ATMs? Non-Profit or Charity?
[ | Yes /fyes, customer must provide a copy of the [| Yes _ /fyes, a copy of the IRS 501C Designation must be forwarded to BSA Department.

OWNER/SIGNER/BENEF OWNER OWNER/SIGNER/BENEF OWNER

Processor or ISO Agreement AND a copy of the
[x] No ATM equipment Sale or Lease Agreement. No
Forward documentation to the BSA department.

If yes, how does the entity receive contributions?

The Bank DOES NOT Open Money Service Business Accounts.
Contact BSA Department if the customer provides any of the following services.

[| Cash Checks [| Sell Lottery Tickets [| Gaming Activities i.e. Bingo [| Currency Exchanges/Dealers
{ | Money Order Sales [] Prepaid Card Sales [ Third Party Payment Processor [| Exchange of Virtual Currency
[_] Traveler Check Sales [J Money Transmitter

Name CASEY D CROWTHER DOB 09/02/1985

Tax ID 593-688-8937 Phys. Address 6651 NALLE GRADE RD
Residency Status US Citizen NORTH FORT MYERS FL 33917
Citizenship United States Primary ID Drivers License

Employer TARGET ROOFING Secondary ID Social Security Card (2nd ID)
Occupation OWNER OF ROOFING CO

Is customer a Politically Exposed Person (Senior Political Figure, Member of a Senior Political Figure’s immediate family, or a close
associate of a Senior Foreign Political figure?)

[x] No [ | Yes If yes, explain

Name DOB

Tax ID Phys. Address
Residency Status

Citizenship Primary ID
Employer Secondary ID
Occupation

Is customer a Politically Exposed Person (Senior Political Figure, Member of a Senior Political Figure's immediate family, or a close
associate of a Senior Foreign Political figure?)

[ ]No [ ves If yes, explain

EX_106_001


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