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ements of the Practitioner PIN method and Pub. 1345, Handbook for Authorized IRS e-file Providers of Individual Income Tax Returns. ERO's signature Ito. DAVID WEISS CPA, PLLC Date ► 719995 11-10.17 ERO Must Retain This Form - See Instructions Don't Submit This Form to the IRS Unless Requested To
e of activities at each loca ion (manufacturing, sales office. executive and number of employees, their wages salaries and duties at each location. Complete Address Rent Nature of Activities No ry Frnoioyeas Wages, Salaries, Etc. Duties I I I I Total Part 2 List location of each place of business UU I
and 67 through 73. These are your total payments Ito 74 547,000. Refund 75 If line 74 is more than
e of activities at each loca ion (manufacturing, sales office, executive and number of employees, their wages salaries and duties at each location. Complete Address Rent Nature of Activities No Emoroyees Wages, Salaries, Etc. Duties I I I I Total I, Part 2 List location of each place of business UU
. • Extension Granted Granted 0 COS/Extension Ito START HERE - Type or print in black ink. Part 1.
0-1 Extraordinary achievement in motion pictures or television II.a. Name of Labor Organization Apt. Ste. Flr. Number K K K State ZIP Code lib. Complete Address Street Number and Name City or Town 11.c. Date Sent (minicld/yyyy) 12.a. Name of Management Organization I I .d. Daytime Telephone Number Apt.
e is only required to sign as the paid preparer. Ito not necessary to include the ERO signature in thi
dike, executive office. public warehouse, contractor. converter, etc.), and number of employees. their wages, salaries and duties at each location. Complete Address Rent Nature of Actmlies No. cl Employees Wars. Salanes. Etc. Oulias NJA3111MOISCIT 15 WATTS ST. NY, NY Cl., NEW YORK SUR MY 10011 552,00
Entities connected to both Joi Ito and Complete Address

United States
LOCATION
NEW YORK NY
LOCATIONMaria Farmer
PERSON
New York City
LOCATION
U.S. Treasury
ORGANIZATION
New York
LOCATION
the Internal Revenue Service
ORGANIZATIONthe State of New York
LOCATION
New York State
LOCATIONChang
PERSONSpouse
ORGANIZATIONUtilities
ORGANIZATIONYonkers
LOCATION
Medicaid
ORGANIZATIONSchedule SE
PERSONFiler
PERSON
FinCEN
ORGANIZATIONWEISS
ORGANIZATIONDOTTED LINE & MAIL UPPER PORTION
ORGANIZATIONPreparer
ORGANIZATION