Court filing

Exhibit 111 — USA v. Crowther (Dkt. 136.89)

Summary

An Account Agreement from Sanibel Captiva Community Bank dated 06/10/2020, filed 03/31/21 in Case 2:20-cr-00114-JES-M_M as Document 136-89 (exhibit tag EX_111_001). It is marked as an existing account, with the description UPDATE TO ACCT AGMT DTD 4/30/18, Checking, and an initial deposit of $100.00 from an existing account. The owner is an LLC whose business is listed as PROPERTY, and 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 111 — USA v. Crowther (Dkt. 136.89).” U.S. District Court for the Middle District of Florida, No. 2:20-cr-00114, Doc. 136-89, 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-381779-136-89-doc-136-89/, SHA-256 a49688dbd899e26d3cfb7d0cc0a38baec58467cf46ba80e02b19bf69acf4e197.

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Full text

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Case 2:20-cr-00114-JES-M_M Document 136-89 Filed 03/31/21 Page 1of1PagelD

ACCOUNT AGREEMENT _.

2631 1 on

SANIBEL CAPTIVA COMMUNITY BANK
1533 HENDRY STREET SUITE 100

| FORT MYERS FL 33901
i
i

Agreement Date: __ 06/10/2020 _ By: Kristin Dilorio

EXISTING Account - This agreement replaces previous agreement(s).
Account Description: UPDATE TO ACCT AGMT DTD 4/30/18

Checking O Savings 0 NOW L)

Initial Deposit $ 100.00 Source: EXISTING

Account 29068841
Number:

Account Owner(s) Name & Address
3801 JADE AVENUE LLC

1841 ORTIZ AVE
FORT MYERS FL 33905

Qwnership of Account - CONSUMER (Select One and Initial}

©) Single-Party Account C Trust-Separate Agreement
() Multiple-Party Account
[1 Multiple-Party Account - Tenancy by the Entireties _

O other

Rights at Death (Select One and Initial)

1 Single-Panty Account

{J Multipte-Party Account With Right of Survivorship
1 Muttiple-Panty Account Without Right of Survivorship
DD Single-Party Account With Pay On Death

(J Multipte-Party Account With Right of Survivorship
and Pay On Death
Pay-On-Death Seneficlaries. To Add Pay-On-Death Beneficiaries Name One or More:

Ownership of Account - BUSINESS Purpose

1 Sole Proprietorship [1 Single-Member LLC (© Partnership
LLC (LLC tax classification: 1] C Cop (1 SQom OC) Partnersnip)
1 CCorporation ©) S Corporation 1 Non-Frofit
O
Business: PROPERTY

Backup Withholding Certificatlons (Non-’U S. Persons" - Use separate Form W8)

By signing at right, |, CASEY D CROWTHER
certify under penalties of perjury thal the statements made in this section are true.

DJ) TIN: 82-5300988 The Taxpayer tdentificalion
Number (TIN) shown is my correct taxpayer identification number.

Not Subject to Backup Withholding. | am NOT suject to backup
withholding either because | have not bean nolified {hal | am subject 10 backup

withholding as a resuit of a failure 10 report all mtesest or dividends, or the Internal
Revenue Service has notified me thal | am no fonger subject to backup withholding.

1 Exempt Recipient. | am an exempt recipient under the Intemal Revenue
Service Regulations. Exempt payee code (if any)

FATCA Code. The FATCA code entered on this form (if any) indicating thal | am
exempt from FATCA reporting is correct.

U.S. Person. | am a U.S. citizen or other U.S. person (as defined
in the instructions).

Additional Information:

Signeture(s). The undersigned certifies the accuracy of the tnformation he/she has
provided and acknowledges receipt of a completed copy of this form. The undersigned
authorizes the financial institution to verify crecit and employment histery-and/or have
a credit reporting agency prapars 4 credit report on the undersigned, as individuals.
The undersigned also acknowledga the receipt of a copy and agree to the terms of the
follawing agreement{s} and/or disclosure(s):

Terms & Conditions Truth in Savings Funds Availability
Bectronic Fund Transfers Privacy Substitute Checks
© Common Features O

The Internal Revenue Service does not require your consent to any
provision of this document other than the certifications required to
avoid backup withholding.

crowther

(1):

CASEY D CROWTHER .
LD. # C636-104-85-322-0 DOB 09/02/1985
-
(2: Fx ;
LD, # D.O.B.
1.0. # 0.0.8,
(4): [. |
.D. # 0.0.B
O) Convenience Account Agent (Single-Party Accounts Only)

x
1D. # D.O.B8

OBMO2020

Pa
Wolters Kliwer Financ Services ©2016

MPSC-LAZ-FL 1/15/2016
Page 1 of 4

EX_111_001

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Size: 99,154 bytes
SHA-256: a49688dbd899e26d3cfb7d0cc0a38baec58467cf46ba80e02b19bf69acf4e197
Our copy: gov.uscourts.flmd.381779.136.89.pdf
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