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forcement Network (FinCEN) May 2015 Record of Authorization to Electronically File FBARs (See instructions below for completion) Do not send to FinCEN. Retain this form for your records. ANASTAS20170001 The form 114a may be digitally signed Part I I Persons who have an obligation to file a Report
en filed 45 Filer title. if not reporting a personal account 46 Dattlate wlepa Mn the HMO le aottonelIteignel Third Party Preparer Use Only 47 Preparer's last name WEISS 48 First name DAVID 49 MI 50 Check LJ if selfomployedp0096 51 TIN 2062 51a TIN type I XI PTIN 0 SSNATIN Foreign 52 Cont
forcement Network (FinCEN) May 2015 Record of Authorization to Electronically File FBARs (See instructions below for completion) Do not send to FinCEN. Retain this form for your records. TM form 114a may be digitally signed Part I I Persons who have an obligation to file a Report of Foreign Bank a
if not reporting a personal account 146 Date (MWDD Ma date will auto.I N Men the FBAR is ay.t.tionaiit ore, Third Party Preparer Use Only 47 Preparer's last name WEISS 48 First name DAVID 49 M 50 Check if self -employed x 51a TIN type I I PTIN SSNATIN Foreign 52 Contact phone no. sza Ex
cement Network (FinCEN) I May 2015 Record of Authorization to Electronically File FBARs (See instructions below for completion) Do not send to FinCEN. Retain this form for your records. ANASTAS20170001 The fomi 114a may be digitally signed Part I I Persons who have an obligation to file a Report
r title. if not reporting a personal account 146 Date (MM/DD Ma date will auloitnneMn the nswisaanuol el gnea Third Party Preparer Use Only 47 Preparer's last name WEISS 48 First name DAVID 49 MI 50 Checks I if so-mow/3O)00962062 51 TIN 51a TIN type I XI PTIN SSNATIN Foreign 52 Contact pho
forcement Network (FinCEN) May 2015 Record of Authorization to Electronically File FBARs (See instructions below for completion) Do not send to FinCEN. Retain this form for your records. NEXTMAN20160001 The form 114a may be digitally signed Part I Persons who have an obligation to file a Report
not reporting a personal account 146 Date (MWDD Ihka date will auto-I N Men the HMO is asyttionaIlt signed Third Party Preparer Use Only 47 Preparer's last name PRESS 48 First name GARY 49 MI W 50 Checks I if 51 TIN self-employed 51a TIN type I XI PTIN 0 SSNATIN C Foreign Wa Ext. 53 Fi
Entities connected to both FinCEN and Preparer

Jeffrey Epstein
PERSON
United States
LOCATIONLeon Black
PERSON
New York City
LOCATIONFiler
PERSON
U.S. Treasury
ORGANIZATION
New York
LOCATIONMaria Farmer
PERSON
Joi Ito
PERSON
Department of Homeland Security
ORGANIZATIONSpouse
ORGANIZATIONFBI
ORGANIZATION
Homeland Security
ORGANIZATION
George W. Bush
PERSON
New York State
LOCATIONTHOMAS - Enhanced
ORGANIZATIONthe New York State Tax Department
ORGANIZATION
NEW YORK NY
LOCATIONNew York State Sales Tax
ORGANIZATIONBSA Efiling
ORGANIZATION