Court filing

Exhibit 121 — USA v. Crowther (Dkt. 136.99)

Summary

An Account Agreement from Sanibel Captiva Community Bank for 8790 Laredo LLC, filed 03/31/21 in Case 2:20-cr-00114-JES-M_M as Document 136-99 (exhibit tag EX_121_001). The account description is COMMERCIAL BUILDING, Checking, with an initial deposit of $1,000.00 whose source is printed as CHECK. The business is listed as a commercial building for a roofing company, and the backup withholding certification names Steven D Adkins.

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 121 — USA v. Crowther (Dkt. 136.99).” U.S. District Court for the Middle District of Florida, No. 2:20-cr-00114, Doc. 136-99, 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-381779-136-99-doc-136-99/, SHA-256 af119cbb1a8c4754e7d41055b3a592ae3cdcd23ca125f8fedc9533e0e472fef4.

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Full text

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Case 2:20-cr-00114-JES-M_M Document 136-99 Filed 03/31/21 Page 1of1PagelD

2669
6 ” . .
ACCOUNT AGREEMENT
SANIBEL CAPTIVA COMMUNITY BANK Account 29068115
1533 HENDRY STREET SUITE 100 Number.

FORT MYERS FL 33901 Account Owner(s) Name & Address
8790 LAREDO LLC

Agreement Date: 4/512018 By: KRISTIN DIORIO
1 EXISTING Account - This agreement replaces previous agreement(s).
Account Description: COMMERCIAL BUILDING

Checking (2 Savings C1 now 0 2043 WEST FIRST ST
Initial Deposit $ 1,000.00 Source: CHECK FORT MYERS FL 33904
Ownership of Account - CONSUMER (Select One and Initial) Additional information:

O Singie-Party Account CJ Trust-Separate Agreement ___.

(2 Muttipie-Party Account
(O Multipte-Party Account - Tenancy by the Entireties _
() Other

Rights at Death (Select One and Initial)

(2 Single-Party Account _
i ccout Survivershi Signature(s). The undersigned certifies the accuracy of the infermation he/she has
0 Mullipie-Perty “ at With Right of A ° . provided and acknowledges receipt of a completed copy of this form. The undersigned
(C1 Muttipte-Party Account Without Right of Survivorship | _—________ authorizes the financial institution to verify credit and employment history andlor have
Death acredit reporting agency prepare a credit report ont undersigned, asi ua

Cl Singte-Party Account With Pay On . . The undersigned also acknowledge the receipt of a copy and agree to the terms of the
(1) Multipte-Party Account With Right of Survivorship = ______ following agreement(s) and/or disclosure(s):

and Pay On Death _. Terms & Conditions & Truth in Savings &} Funds Availability

R! Gectronic Fu ansfers Privacy Substitute Checks
1 Common Feathres\ 0 ~~

The internal Revenue ice d nofrequire your consent to any
provision of this Hocument other the certificatigns required to
avoid backup withholding. 7

04/10/1967

Ownership of Account - BUSINESS Purpose

(© Sole Proprietorship [ Single-Member LLC (2 Partnership

KH LLC (LC tax classification: O cam 0 sap (3 Partnership) (2): Bye.

© CCorporation [) S Corporation (0 Non-Profit ; casey BD CRONTHER
. # C636-104-85-322-0

Business: COMMERCIAL BUILDING FOR ROOFING CO LD. # p.0.8. __09/02/1985

Backup Withholding Certifications (Non-"U.S. Persons” - Use separate Form W8) (3):

By signing at right, |, STEVEN D ADKINS
certify under penalties of perjury that the statements made in this section are true.

R) TIN: 82-4915465 The Taxpayer Identification LD. # 0.0.8.

Number (TIN) shown is my correct taxpayer identification number. |

Not Subject to Backup Withholding. iam NOT subject to backup (4) Ix
withholding either because | have not been nolified that | am subject to backup
withholding as a result of a failure to report all interest or dividends. or the Interna!
Revenue Service has notified me that | am no longer subject to backup withholding, iD # DOB
1 Exempt Recipient. | am an exempt recipient under the Intema! Revenue ( Convenience Account Agent (Single-Party Accounts Only)
Service Regulations. Exempt payee code (if any)
FATCA Code. The FATCA code entered on this form (if any) indicating that | am
_ exempt from FATCA reporting is correct. x

U.S. Person. lam a U.S. citizen or other U.S. person (as defined
In the Instructions). ” ID # DOR

04/05/2018

Sauers TY VMPe PSC-LAZ.
ons
Wolters Kiuwer Financial Services ©2016 M er ort

EX_121_001

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Size: 99,006 bytes
SHA-256: af119cbb1a8c4754e7d41055b3a592ae3cdcd23ca125f8fedc9533e0e472fef4
Our copy: gov.uscourts.flmd.381779.136.99.pdf
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