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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
above P"' Taxable refunds, credits, or offsets of state and local income taxes Alimony received Business income or (loss). Attach Schedule C or C-EZ Capital gain or (loss). Attach Schedule D if required. If not required, check here ► 7 8a 740. 9a 10 11 12 13 14 15b 16b 17 18 19
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
through 35 Taxable refunds, credits, or offsets of state and local income taxes Alimony received Business income or (loss). Attach Schedule C or C-EZ ► 7 8a 755. 9a 10 11 12 13 14 15b 16b 17 18 19 20b 21 22 1,645,828. ► 1,646,583. Adjusted Gross Income 23 24 25 26 2
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
ets of state and local income taxes 10 1099-R if tax was withheld. 11 Alimony received 11 12 Business income or (loss). Attach Schedule C or C-EZ 12 13 Capital gain or (loss). Attach Schedule D U required. If not required, ohm* here 13 If you did not get a W-2, 14 Other gains or (los
Entities connected to both Empire State and C-EZ

United States
LOCATIONSpouse
ORGANIZATIONthe Foreign Earned Income Tax Worksheet
ORGANIZATIONERO Signature
ORGANIZATION
U.S. Treasury
ORGANIZATIONFiler
PERSONSchedule SE
PERSONthe U.S. Treasury Financial Agent
ORGANIZATION
FinCEN
ORGANIZATIONTHE NY TAX DEPT
ORGANIZATION
New York
LOCATIONNY State
ORGANIZATION
New York State
LOCATIONConservation Reserve Program
ORGANIZATIONthe New York State Tax Department
ORGANIZATIONWomen's Cancers Education and Prevention Fund
ORGANIZATIONFirst Installment
ORGANIZATIONNY City
LOCATIONJurat/Disclosure
ORGANIZATIONBreast Cancer Research Fund
ORGANIZATION