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
York State column: subtract line 18 from line f 7; New York City column: enter amount from line 17) 20 Refundable credits (see instructions) 21 NYS/NYC estimated income tax (subtract line 20 front line 19) 22 Yonkers: (a) resident tax surcharge (multiply line 21, New York State column, by f 6.75% (
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
w York State column: subtract line 18 from line 17; New York City column: enter amount from line 17) 20 Refundable credits (see instructions) 21 NYS/NYC estimated income tax (subtract line 20 from line 19) 22 Yonkers: (a) resident tax surcharge (multiply line 21, New York State column, by 16.75% (16
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
w York State column: subtract line 18 from line 17; New York City column: enter amount from line 17) 20 Refundable credits (see instructions) 21 NYS/NYC estimated income tax (subtract line 20 (mm Nne 19) 22 Yonkers: (a) resident tax surcharge (multiply fine 21, New York State column, by 16.75% (1675
Entities connected to both FinCEN and NYS/NYC

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