3
Shared Docs
3
Same-Page
3 / 3
Mentions
mated tax, and the financial institution to debit the entry to this account. This authorization is to remain in full force and effect until I notify the U.S. Treasury Financial Agent to terminate the authorization. To revoke (cancel) a payment I must contact the U.S. Treasury Financial Agent at 1-888-3534537. Payment cancellation
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
mated tax, and the financial institution to debit the entry to this account. This authorization is to remain in full force and effect until I notify the U.S. Treasury Financial Agent to terminate the authorization. To revoke (cancel) a payment I must contact the U.S. Treasury Financial Agent at 1-888-353-4537. Payment cancellatio
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
mated tax, and the financial institution to debit the entry to this account. This authorization is to remain in full force and effect until I notify the U.S. Treasury Financial Agent to terminate the authorization. To revoke (cancel) a payment I must contact the U.S. Treasury Financial Agent at 1-888-353-4537. Payment cancellatio
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 the U.S. Treasury Financial Agent and FBAR S gnature

U.S. Treasury
ORGANIZATIONSpouse
ORGANIZATIONC-EZ
ORGANIZATIONthe Foreign Earned Income Tax Worksheet
ORGANIZATIONSchedule SE
PERSON
FinCEN
ORGANIZATIONFiler
PERSON
United States
LOCATIONERO Signature
ORGANIZATIONUtilities
ORGANIZATIONJurat/Disclosure
ORGANIZATIONPreparer
ORGANIZATION
Joi Ito
PERSONthe Foreign Bank and Financial Accounts Report
ORGANIZATIONForeign Bank
ORGANIZATIONBSA Efiling
ORGANIZATIONConservation Reserve Program
ORGANIZATIONConservation Reserve
ORGANIZATIONJohn O. Smith
PERSONthe New York State Tax Department
ORGANIZATION