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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
through 35 Taxable refunds, credits, or offsets of state and local income taxes Alimony received Business income or (loss). Attach Schedule C or C-EZ ► 7 8a 755. 9a 10 11 12 13 14 15b 16b 17 18 19 20b 21 22 1,645,828. ► 1,646,583. Adjusted Gross Income 23 24 25 26 2
and 67 through 73. These are your total payments Ito 74 547,000. Refund 75 If line 74 is more than
ets of state and local income taxes 10 1099-R if tax was withheld. 11 Alimony received 11 12 Business income or (loss). Attach Schedule C or C-EZ 12 13 Capital gain or (loss). Attach Schedule D U required. If not required, ohm* here 13 If you did not get a W-2, 14 Other gains or (los
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STMT 3 $TMT 5 10 0. 1099-R if tax was withheld. 11 Alimony received 11 12 -99,490. 12 Business income or (loss). Attach Schedule C or C-EZ If you did not get a W-2, see instructions. 13 14 15a Capital gain or (loss). Attach Schedu Other gains or (losses). Attach Form IRA distri
015I 35 EFTA00026323 Form 4797 Deparbrienl a Ito Troosmy Internal ROvOnue Service NamerS}Sn0wn o
dividends Taxable refunds, credits, or offsets of state and local income taxes Alimony received Business income or (loss). Attach Schedule C or C-EZ Capital gain or (loss). Attach Schedule D if required. If not required, check here Other gains or (losses). Attach Form 4797 IRA distnbutians
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