3
Shared Docs
3
Same-Page
3 / 3
Mentions
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
2 Total tax (Form 1040, line 63; Form 1040A. line 39; Form 1040EZ, line 12; Form 1040NR. line 61) 2 584,587. 3 Federal income tax withheld from Forms W2 and 1099 (Form 1040, line 64; RIM 1040A, line 40; Form 1040EZ. line 7; Form 1040NR, lie 62a) 4 Refund (Form 1040, line 76a; Form 1040A. line 48a;
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
2 Total tax (Form 1040. line 63; Form 1040A, line 39; Form 1040EZ, line 12; Form 1040NR, line 61) 2 584,894. 3 Federal income tax withheld from Forms W2 and 1099 (Form 1040• line 64; Form 1040A, line 40; Form 1040€2, line 7; Form 104014R, line 62a) 4 Refund (Form 1040, line 76a; Form 1040A, line 48
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
2 Total tax (Form 1040. line 63; Form 1040A, line 39; Form 1040EZ, line 12; Form 1040NR, line 61) 2 556,671. 3 Federal income tax withheld from Forms W2 and 1099 (Form 1040, line 64; Ft:10111040A, line 40; Form 1040EZ, line 7; Form 104014R, line 62a) 4 Refund (Form 1040, line 76a; Form 1040A, line
Entities connected to both FinCEN and Forms W2

United States
LOCATION
New York City
LOCATIONFiler
PERSON
New York
LOCATION
U.S. Treasury
ORGANIZATIONMaria Farmer
PERSONSpouse
ORGANIZATION
Joi Ito
PERSONPreparer
ORGANIZATIONthe Foreign Earned Income Tax Worksheet
ORGANIZATIONthe Foreign Bank and Financial Accounts Report
ORGANIZATIONFBAR S gnature
ORGANIZATION
New York State
LOCATIONthe U.S. Treasury Financial Agent
ORGANIZATIONConservation Reserve Program
ORGANIZATIONConservation Reserve
ORGANIZATIONERO Signature
ORGANIZATIONC-EZ
ORGANIZATIONJurat/Disclosure
ORGANIZATIONForeign Bank
ORGANIZATION