Western Union Remission

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File a Petition for Remission

Petition for Remission

Please provide your current contact information

*First Name

STEPHEN M.I.

*Last Name

BOURQUE

Please provide your current mailing address.

Please check if a
non-U.S. address

*Primary Address

2241 REGENT WAY

 Continuation of
Primary Address

*City

Castro Valley

*State

California

*Zip Code 94546

Telephone number
(415) 430-5810
(home)

Telephone number
(work)

Telephone number
(415) 430-5810
(mobile)

Email Address

animal-doctor@hotmail.com

Petition for Remission Submission

On January 19, 2017, The Western Union Company (Western Union),

paid $586 million to settle charges brought by the Federal Trade
Commission (or FTC) and the Department of Justice (or DOJ). The
company admitted to criminally aiding and abetting wire fraud and to
violations of the Bank Secrecy Act. The U. S. Postal Inspection Service
investigated various schemes in which fraudsters contacted victims and
falsely posed as family members in need or federal law enforcement
o cials, or falsely promised prizes, loans, employment opportunities,
discounted products or other nancial awards. The fraudsters directed
the victims to send money through Western Union to help relatives,
avoid imprisonment or arrest, or to claim prizes, receive loans,
employment, products or some other nancial award. No one received
the cash, prizes or other promised items.

If you wired funds from a Western Union location between January 1,

2004, to January 19, 2017, and believe you were a victim of the fraud
described above, please complete the information below and submit
this form by 02/12/2018 to be considered for remission.

Please enter your transaction information in the section(s) below.

Each transaction must be listed separately.

Please supply any available documentation (For example: Western

Union transfer send form and/or receipt) to support your claim. Do not
send original documents. Only the amount of the transfer will be
included in approved remission amounts. Collateral expenses such as
wire transfer fees, incidental losses, or transfers sent through other
businesses are not recoverable through the remission process.

*How much money did you transfer through Western Union to the
perpetrators?
(Only include the amount of the transfer, not transaction fees.)
$ 25103.60

If you did not send U.S. dollars please select your currency:
select
*On what date was the Western Union Money Transfer
transaction performed? Control Number (MTCN):
10/01/2008
City and State/Province where Western Union transfer initiated:
City State Zip
EDMONTON Select

Foreign Province Foreign Postal Foreign Country

ALBERTA Code CANADA
T8T 0L6
*Destination Country for funds transferred through Western Union:

UNITED STATES
*How much money did you transfer through Western Union to the
perpetrators?
(Only include the amount of the transfer, not transaction fees.)
$ 355.00
If you did not send U.S. dollars please select your currency:

select
*On what date was the Western Union Money Transfer
transaction performed? Control Number (MTCN):
12/11/2012
City and State/Province where Western Union transfer initiated:
City State Zip

EDMONTON Select
Foreign Province Foreign Postal Foreign Country

ALBERTA Code
CANADA
T8T 0L6
*Destination Country for funds transferred through Western Union:

UNITED STATES

*How much money did you transfer through Western Union to the
perpetrators?
(Only include the amount of the transfer, not transaction fees.)
$ 304.39
If you did not send U.S. dollars please select your currency:

select
*On what date was the Western Union Money Transfer
transaction performed? Control Number (MTCN):

12/12/2012
City and State/Province where Western Union transfer initiated:
City State Zip

EDMONTON Select
Foreign Province Foreign Postal Foreign Country

ALBERTA Code
CANADA
T8T 0L6
*Destination Country for funds transferred through Western Union:

UNITED STATES

*How much money did you transfer through Western Union to the
perpetrators?
(Only include the amount of the transfer, not transaction fees.)
$ 1047.99
If you did not send U.S. dollars please select your currency:

select
*On what date was the Western Union Money Transfer
transaction performed? Control Number (MTCN):
10/13/2012
City and State/Province where Western Union transfer initiated:
City State Zip

EDMONTON Select
Foreign Province Foreign Postal Foreign Country

ALBERTA Code
CANADA
T8T 0L6
*Destination Country for funds transferred through Western Union:

UNITED STATES

*How much money did you transfer through Western Union to the
perpetrators?
(Only include the amount of the transfer, not transaction fees.)
$ 1000.00
If you did not send U.S. dollars please select your currency:

select
*On what date was the Western Union Money Transfer
transaction performed? Control Number (MTCN):

08/09/2012 8544551223
City and State/Province where Western Union transfer initiated:
City State Zip

EDMONTON Select
Foreign Province Foreign Postal
Foreign Province Foreign Postal
Foreign Country
ALBERTA Code
CANADA
T8T 0L6
*Destination Country for funds transferred through Western Union:

UNITED STATES

*How much money did you transfer through Western Union to the
perpetrators?
(Only include the amount of the transfer, not transaction fees.)
$ 4027.34
If you did not send U.S. dollars please select your currency:

select
*On what date was the Western Union Money Transfer
transaction performed? Control Number (MTCN):

06/05/2009
City and State/Province where Western Union transfer initiated:
City State Zip

EDMONTON Select
Foreign Province Foreign Postal Foreign Country

ALBERTA Code
CANADA
T8T 0L6
*Destination Country for funds transferred through Western Union:

UNITED STATES

*How much money did you transfer through Western Union to the
perpetrators?
(Only include the amount of the transfer, not transaction fees.)
$ 2369.92
If you did not send U.S. dollars please select your currency:

select
*On what date was the Western Union Money Transfer
transaction performed? Control Number (MTCN):
06/04/2012

City and State/Province where Western Union transfer initiated:

City and State/Province where Western Union transfer initiated:
City State Zip
EDMONTON Select
Foreign Province Foreign Postal Foreign Country

ALBERTA Code
CANADA
T8T 0L6
*Destination Country for funds transferred through Western Union:

UNITED STATES

*How much money did you transfer through Western Union to the
perpetrators?
(Only include the amount of the transfer, not transaction fees.)
$ 2500
If you did not send U.S. dollars please select your currency:

select
*On what date was the Western Union Money Transfer
transaction performed? Control Number (MTCN):
11/26/2014
City and State/Province where Western Union transfer initiated:
City State Zip
EDMONTON Select
Foreign Province Foreign Postal Foreign Country

ALBERTA Code
CANADA
T8T 0L6
*Destination Country for funds transferred through Western Union:

UNITED STATES

add transaction

undo last transaction

Check this box if you have previously recovered funds

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Declaration

* I understand that the information I am providing in support

of my petition will be used to determine my eligibility for a
payment. I hereby declare under penalty of perjury under the
laws of the United States of America that I believe that all
information on this form or included in support of my petition is
true and correct. I further certify that I have not altered any
documents submitted in support of my petition.
 Check this box if you do not have a Social Security Number or
an Individual Taxpayer Identi cation Number

*Social Security Number (this is only required for U.S. Citizens)

or Individual Taxpayer Identi cation Number

622-65-7391

For more information on the requirement to provide your SSN

or ITIN, please see FAQ #12

Agree and Submit

*Required

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