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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
5 • June 15 = (61 365) x 7.5% = .01253 - Or - April 15 l* 365)x 7.5%= • 32 Multiply line 30. column A by line 31 30 31 32 2965.00 37 oc. Second Installment (June 15 - September 15, 20 7) 33 June 15 • September 15 = (92 365) x 7.5% = .01890 June 15. =( 365) x 7.5% = 34 Multiply line 30. column 8 by l
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
5 • June 15 = (61 365) x 7.5% = .01253 - Or - April 15 l* 365)x 7.5%= • 32 Multiply line 30. column A by line 31 30 31 32 2965.00 37 oc. Second Installment (June 15 - September 15, 20 7) 33 June 15 • September 15 = (92 365) x 7.5% = .01890 June 15. =( 365) x 7.5% = 34 Multiply line 30. column 8 by l
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
5 • June 15 = (61 365) x 7.5% = .01253 - or - April 15 • It365)x 7.5%. • 32 Multiply line 30. column A by line 31 30 31 32 1111 co 14 cc Second Installment (June 16 - September 15, 20 7) 33 June 15 September 15 = (92 + 365) x 7.5% = .01890 June 15. =( + 365) x 7.5% = • 34 Multiply line 30, column B
Entities connected to both FinCEN and Second Installment

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