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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
instructions) b Adjustment for net income or loss derived in the ordinary course of a non•section 1411 trade or business (see instructions) c Combine Ines 4a and 4b 6a Net gain or loss from disposition of property (see instructions) b Net gain or loss from disposition of property that is not subject
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
40, line 17; or Form 1041, line 5) b Adjustment for net income or loss derived in the ordinary course of a ncri.section 1411 trade or business e Combine Ines 4a and 4b 5a Net gain or loss from disposition of property from Fenn 1040. combine lines 13 and 14; or from Form 1041. combine lines 4 and 7 b Net
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
instructions) b Adjustment for net income or loss derived in the ordinary course of a non•section 1411 trade or business (see instructions) c Combine Ines 4a and 4b 6a Net gain or loss from disposition of property (see instructions) b Net gain or loss from disposition of property that is not subject
Entities connected to both FinCEN and Combine Ines 4a

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
ORGANIZATIONQualifying widow(er
ORGANIZATION