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017) 62 Enter amount from line 61 Payments and refundable credits (see pages 28 through 31) 76801). It -ti -17 62 193792.00 63 64 65 66 67 Empire State child credit NYS/NYC child and dependent care credit 63 .00 64 .00 NYS earned income credit (BC) 65 .00 NYS noncustodial parent EIC Real
m 15) employer's (En ity) name DAVID WEISS CPA, PLLC 25. Employer EIN **_*** 26. Preparers ignature DAVID WEISS Instructions for completing the FBAR S gnature Authorization Record This record may be completed by the individual or entity granting such authorization (Part I) OR the individuaVentity authorize
Page 4 of 4 IT-201 (2017) 768001 11-17-N. 62 Enter amount from line 61 Payments and refundable credits (see pages 28 through 31) 62 1938750o 63 Empire State child credit 63 .00 64 NYS/NYC child and dependent care credit 64 .00 65 NYS earned income credit (BC) 65 .00 66 NYS noncustodial parent E
rs (item 15) employer's (En ity) name DAVID WEISS CPA, PLLC 25. Employer EIN 26. Preparers signature DAVID WEISS Instructions for completing the FBAR S gnature Authorization Record This record may be completed by the individual or entity granting such authorization (Part I) OR the individuaVentity authorize
security umber 765004 11.17.17 62 Enter amount from line 61 816 IPayments and refundable credltel (see pages 28 through 31) 63 64 65 66 67 Empire State child credit NYS/NYC child and dependent care credit 63 .00 64 .00 NYS earned income credit (BC) 65 .00 NYS noncustodial parent EIC Real
5) employers (En ity) name DAVID WEISS CPA, PLLC 25. Employer EIN **-***2756 26. Preparers ignature DAVID WEISS Instructions for completing the FBAR S gnature Authorization Record This record may be completed by the individual or entity granting such authorization (Part I) OR the individuaVentity authorize
Entities connected to both Empire State and FBAR S gnature

United States
LOCATIONSpouse
ORGANIZATIONFiler
PERSONFirst Installment
ORGANIZATIONBSA Efiling
ORGANIZATIONPreparer
ORGANIZATION
New York City
LOCATIONPersonal Income Tax Information Center
ORGANIZATION
U.S. Treasury
ORGANIZATION
New York
LOCATIONNY State
ORGANIZATION
New York State
LOCATIONYonkers
LOCATIONthe New York State Tax Department
ORGANIZATIONWomen's Cancers Education and Prevention Fund
ORGANIZATIONNY City
LOCATION
FinCEN
ORGANIZATIONBreast Cancer Research Fund
ORGANIZATIONTHE NY TAX DEPT
ORGANIZATIONNYC-210
ORGANIZATION