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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
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
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
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
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 (
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 NY State and THE UNITED STATES TREASURY

the Internal Revenue Service
ORGANIZATION
New York State
LOCATION
New York
LOCATION
United States
LOCATIONINTERNAL REVENUE SERVICE CENTER
ORGANIZATION
Empire State
LOCATIONBreast Cancer Research Fund
ORGANIZATIONFirst Installment
ORGANIZATIONMaria Farmer
PERSONSpouse
ORGANIZATIONPersonal Income Tax Information Center
ORGANIZATIONthe New York State Tax Department
ORGANIZATIONTHE NY TAX DEPT
ORGANIZATIONNYC-210
ORGANIZATIONWomen's Cancers Education and Prevention Fund
ORGANIZATIONNY City
LOCATIONthe New York State Department of Taxation and Finance
ORGANIZATIONYonkers
LOCATIONPreparer
ORGANIZATIONFiler
PERSON