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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
f activities at each loca ion (manufacturing, sales office. executive , and number of employees, their " ages salaries and duties at each location. Complete Address Rent Nature of Activities Empioyees Wages, Salaries, Etc. Duties I I I I Total Illl• Part 2 List location of each place of business UU
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
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
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
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
Entities connected to both FinCEN and Complete Address

United States
LOCATION
New York City
LOCATIONFiler
PERSON
New York
LOCATION
U.S. Treasury
ORGANIZATIONMaria Farmer
PERSON
Joi Ito
PERSONthe State of New York
LOCATIONSpouse
ORGANIZATIONthe Foreign Earned Income Tax Worksheet
ORGANIZATIONthe Commercial Rent Tax Return
ORGANIZATIONC-EZ
ORGANIZATIONSchedule SE
PERSONBusiness Tax Credit
ORGANIZATION
New York State
LOCATIONthe U.S. Treasury Financial Agent
ORGANIZATIONConservation Reserve Program
ORGANIZATIONJurat/Disclosure
ORGANIZATIONthe New York State Department of Taxation and Finance
ORGANIZATIONthe Foreign Bank and Financial Accounts Report
ORGANIZATION