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instructions) 2 Empire State child credit (from Form IT-201, fine 63) 3 NYS/NYC child and dependent care credit (from Form IT-201, line 64) 4 NY State earned income credit (EIC) (from Form IT-201, line 65) 5 NY State noncustodial parent EIC (from Form IT-201, fine 66) 6 Real property tax credit
lost (Replacement requested) Late receiving missing required account information Unable to obtain joint spouse signature in time Unable to access BSA Efiling system Other (please provide explanation below) 773151 05-21-17 EFTA00792088 FinCEN Form 114 REPORT OF FOREIGN BANK AND FINANCIAL ACCOUNTS Do
instructions) 2 Empire State child credit (from Form IT-201, fine 63) 3 NYS/NYC child and dependent care credit (from Form IT-201, fine 64) 4 NY State earned income credit (EIC) (from Form IT-201, line 65) 5 NY State noncustodial parent EIC (from Form IT-201, fine 66) 6 Real property tax credit
lost (Replacement requested) Late receiving missing required account information Unable to obtain joint spouse signature in time Unable to access BSA Efiling system Other (please provide explanation below) 773151 05-21-17 EFTA00792178 FinCEN Form 114 REPORT OF FOREIGN BANK AND FINANCIAL ACCOUNTS Do
N) ***** 9816 2 Empire State child credit (from Form IT-201, fine 63) 3 NYS/NYC child and dependent care credit (from Form IT-201, fine 64) 4 NY State earned income credit (EIC) (from Form IT-201, Nne 65) 5 NY State noncustodial parent EIC (from Form IT-201, fine 66) 6 Real property tax credit (
lost (Replacement requested) Late receiving missing required account information Unable to obtain joint spouse signature in time Unable to access BSA Efiling system Other (please provide explanation below) 773151 05-21-17 EFTA00792000 FinCEN Form 114 REPORT OF FOREIGN BANK AND FINANCIAL ACCOUNTS Do
Entities connected to both NY State and BSA Efiling

New York State
LOCATIONSpouse
ORGANIZATION
the Internal Revenue Service
ORGANIZATION
George W. Bush
PERSON
New York
LOCATION
United States
LOCATIONPersonal Income Tax Information Center
ORGANIZATIONBreast Cancer Research Fund
ORGANIZATIONMaria Farmer
PERSONYonkers
LOCATIONFiler
PERSON
FinCEN
ORGANIZATIONNYC-210
ORGANIZATION
Empire State
LOCATIONFirst Installment
ORGANIZATION
U.S. Treasury
ORGANIZATIONthe New York State Tax Department
ORGANIZATIONWomen's Cancers Education and Prevention Fund
ORGANIZATIONNY City
LOCATIONthe New York State Department of Taxation and Finance
ORGANIZATION