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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
above P"' 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 ► 7 8a 740. 9a 10 11 12 13 14 15b 16b 17 18 19
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
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
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
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
n 114 and 8938 - Foreign Assets worksheet, Form 114 Filer Information section, Date Signed by Filer-Override field. Future dates are not allowed by FinCEN. (24421) • Massachusetts. For the 2017 tax year taxpayers must file and make extension payments electronically if making a payment of $5,000 or m
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
Entities connected to both FinCEN and C-EZ

Ghislaine Maxwell
PERSON
United States
LOCATION
New York City
LOCATIONFiler
PERSON
U.S. Treasury
ORGANIZATION
New York
LOCATIONMaria Farmer
PERSONSpouse
ORGANIZATION
Joi Ito
PERSONthe Foreign Earned Income Tax Worksheet
ORGANIZATIONthe U.S. Treasury Financial Agent
ORGANIZATIONERO Signature
ORGANIZATIONSchedule SE
PERSONJurat/Disclosure
ORGANIZATION
George W. Bush
PERSONConservation Reserve
ORGANIZATION
Adriana Ross
PERSONConservation Reserve Program
ORGANIZATION
Woody Allen
PERSONFOREIGN BANK AND FINANCIAL
ORGANIZATION