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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
ICE. WE WILL THEN TRANSMIT YOUR FORM TO THE FINCEN. 700397 040147 EFTA00792087 FINANCIAL CRIMES ENFORCEMENT NETWORK BSA E-Filing - Report of Foreign Bank and Financial Accounts (FBAR) ANASTAS20170001 Filing Name ANASTASIYA SIROOCHENKO Submission Type NEW PIN NOT REQUIRED FinCEN Form 114 Check her
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
UR OFFICE. WE WILL THEN TRANSMIT YOUR FORM TO THE FINCEN. 04 0t .7 EFTA00792177 FINANCIAL CRIMES ENFORCEMENT NETWORK BSA E-Filing - Report of Foreign Bank and Financial Accounts (FBAR) Filing Name ANASTASIYA SIROOCHENKO Submission Type NEW PIN NOT REQUIRED FInCEN Form 114 Check here if this report
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
T YOU RETAIN THIS COPY INDEFINITELY. VERY TRULY YOURS, DAVID WEISS EFTA00791999 FINANCIAL CRIMES ENFORCEMENT NETWORK BSA E-Filing - Report of Foreign Bank and Financial Accounts (FBAR) ANASTAS20170001 Filing Name ANASTASIYA SIROOCHENKO Submission Type NEW PIN NOT REQUIRED FinCEN Form 114 Check her
Entities connected to both Empire State and Foreign Bank

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