Exhibit 112 — USA v. Crowther (Dkt. 136.90)

Summary

Exhibit 112, filed March 31, 2021 as Document 136-90 in United States v. Crowther, is a Community Bank business new account scorecard for an LLC set up to hold residential rental income property. It shows the account opened by Kristin DiIorio on 04/30/2018, with rental income as the source of deposits and the purpose as rentals, and an expected average monthly balance of $5,004 - $10,000. It lists two owner/signers, Steven D Adkins, a VP of a roofing company, and Casey D Crowther, owner of a roofing company, both with employer Target Roofing. The form also prints identifiers and addresses for them, which are not copied here.

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Record facts

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2

COMMUNITY BANK

Opened By KRISTIN DIIORIO BUSINESS NEW ACCOUNT SCORECARD
5] Date Opened 04/30/2018 Account# 29068841 Source of Deposits RENTAL INCOME
5 Initial Deposit 100.00 Account Type LLC Purpose of this Acct RENTAL
S)
z Expected Avg Monthly Balance $5,004 - $10,000 Expected ACH Activity DOMESTIC
Expected Wire Activity DOMESTIC Monthly ACH Amount $0 - $10,000
Monthly Wire Frequency 1-4 Monthly Cash In/Out Amount $0 -$500
Monthly Wire Amount $0 - $10,000 Monthly Cash In/Out Frequency LESS THAN 5
| Business Name 3801 JADE AVENUE LLC New or existing customer? Is there a store front?
=
fa Tax 1B 82-5300988 New Yes
wm} Physical Address 2043 WEST FIRST ST C4 _ c] ”
i FORT MYERS FL_33901 aranng 0
Q State Where Registered LEE COUNTY FL Internet Gambling Business?
@! Description of Business RESIDENTIAL RENTAL INCOME PROPERTY [| Yes ifyes, DO NOT OPEN.

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

Primary Trade Area LOCAL [x] 196
Own/Maintain ATMs? Non-Profit or Charity?
[] Yes If yes, customer must provide a copy of the [| Yes /fyes, a copy of the IRS 501C Designation must be forwarded to BSA Department.

Processor or |SO Agreement AND a copy of the

No ATM equipment Sale or Lease Agreement. X| 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 [| Money Transmitter

—_— STEVEN D ADKINS DOB 04/10/1967

Tax ID 287-54-5858 Phys. Address 17651 WELLS RD

Residency Status US Citizen N FORT MYERS FL 33917
Citizenship United States Primary ID Drivers License

Employer TARGET ROOFING Secondary ID Other

Occupation VP 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?)

No [ | Yes If yes, explain

Name CASEY D CROWTHER DOB 09/02/1985

Tax ID 593-88-8937 Phys. Address 3950 WILLIAMSON RD
Residency Status US Citizen FORT MYERS FL 33905
Citizenship United States Primary ID Drivers License

Employer TARGET ROOFING Secondary ID Other

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?)

No [ ] Yes If yes, explain

EX 112 001

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gov.uscourts.flmd.381779.136.90.pdf

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