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ions (but not those of NYS or its local governments) 21 Public employee 414(h) retirement contributions from your wage s tatements (see page 16) 22 New York's 529 college savings program distributions (see 23 Other (Form 1T-225, line 9) 24 Add lines 19 through 23 New York subtractions (see page 17) 2
END THIS RECORD TO FinCEN UNLESS REQUESTED TO DO SO. 720011 04.01.17 Rev. 10.7 May 21, 2015 EFTA00792092 ENCLOSE A CHECK FOR $500000, PAYABLE TO THE UNITED STATES TREASURY. INCLUDE YOUR SOCIAL SECURITY NUMBER, DAYTIME PHONE NUMBER, AND THE WORDS "2017 FORM 4868" ON YOUR CHECK. MAIL AS SOON AS POSSIBLE TO: INTERNAL R
ons (but not those of NYS or its local governments) 21 Public employee 414(h) retirement contributions from your 4lage statements (sea Page 16) 22 New York's 529 college savings program distributions 23 Other (Form IT-225, line 9) 24 Add lines 19 through 23 New York subtractions (see page 17) 25 Taxabl
END THIS RECORD TO FInCEN UNLESS REQUESTED TO DO SO. 720011 04-01.17 Rev. 10.7 May 21, 2015 EFTA00792182 ENCLOSE A CHECK FOR $500000, PAYABLE TO THE UNITED STATES TREASURY. INCLUDE YOUR SOCIAL SECURITY NUMBER, DAYTIME PHONE NUMBER, AND THE WORDS "2017 FORM 4868" ON YOUR CHECK. MAIL AS SOON AS POSSIBLE TO: INTERNAL R
obligations (but not those of NYS or its local governments) 21 Public employee 414(h) retirement contributions from yo s tatements (seepage 16) 22 New York's 529 college savings program distributions 23 Other (Form 1T-225, line 9) 24 Add lines 19 through 23 New York subtractions (see page 17) 25 Taxabl
SEND THIS RECORD TO FinCEN UNLESS REQUESTED TO DO SO. 720011 0441.17 Rev. 10.7 May 21.2015 EFTA00792004 ENCLOSE A CHECK FOR $500000, PAYABLE TO THE UNITED STATES TREASURY. INCLUDE YOUR SOCIAL SECURITY NUMBER, DAYTIME PHONE NUMBER, AND THE WORDS "2017 FORM 4868" ON YOUR CHECK. MAIL AS SOON AS POSSIBLE TO: INTERNAL R
Entities connected to both New York and THE UNITED STATES TREASURY

United States
LOCATION
New York City
LOCATION
New York State
LOCATIONMaria Farmer
PERSON
NEW YORK NY
LOCATION
U.S. Treasury
ORGANIZATION
Joi Ito
PERSON
the Internal Revenue Service
ORGANIZATIONChang
PERSONUtilities
ORGANIZATION
York City
LOCATION
FinCEN
ORGANIZATIONSpouse
ORGANIZATIONYonkers
LOCATIONNY State
ORGANIZATIONFiler
PERSONthe New York State Tax Department
ORGANIZATIONthe New York State Department of Taxation and Finance
ORGANIZATIONComplete Address
PERSON
Empire State
LOCATION