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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
he following amount for your filing status: Married filing jointly $250,000 Married filing separately $125,000 Single, Head of household, or Qualifying widow(er) $200,000 5 6 Subtract line 5 from line 4. If zero or less. enter 0- 6 7 Additional Medicare Tax on Medicare wages. Multiply line 6 by 0.9% (0.0
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
he following amount for your filing status: Married filing jointly $250,000 Married filing separately $125,000 Single, Head of household, or Qualifying widow(er) $200,000 9 200,000. 10 Enter the amount from line 4 10 11 Subtract line 10 from line 9. If zero or less. enter .0- 11 200,000. 12 Subtract
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
he following amount for your filing status: Married filing jointly $250,000 Married filing separately $125,000 Single. Head of household, or Qualifying widow(er) $200,000 9 200,000. 10 Enter the amount from line 4 10 11 Subtract line 10 from line 9. If zero or less. enter .0- 11 200,000. 12 Subtract
Entities connected to both FinCEN and Qualifying widow(er

United States
LOCATION
New York City
LOCATIONFiler
PERSON
New York
LOCATION
U.S. Treasury
ORGANIZATIONMaria Farmer
PERSON
Joi Ito
PERSONthe Foreign Earned Income Tax Worksheet
ORGANIZATIONSchedule SE
PERSONConservation Reserve Program
ORGANIZATIONConservation Reserve
ORGANIZATIONSpouse
ORGANIZATIONthe Foreign Bank and Financial Accounts Report
ORGANIZATIONthe U.S. Treasury Financial Agent
ORGANIZATIONC-EZ
ORGANIZATIONERO Signature
ORGANIZATIONUtilities
ORGANIZATIONPreparer
ORGANIZATIONFBAR S gnature
ORGANIZATIONCombine Ines 4a
ORGANIZATION