the U.S. Treasury Financial Agent
ORGANIZATIONthe Foreign Bank and Financial Accounts Report
ORGANIZATION3
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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
/bsaefilinglincentreas.gov/main.html for registration). Read and complete the account owner statement in Part I. To authorize a third party to file the Foreign Bank and Financial Accounts Report (FBAR), the account owner should complete Part I. items 1 through 3 (as required), sign and date the document in Part I, items 7)8 and complete item
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
bsaefiling.fincentreas.gov/main.html for registration). Read and complete the account owner statement in Part I. To authorize a third party to file the Foreign Bank and Financial Accounts Report (FBAR), the account owner should complete Part I. items 1 through 3 (as required), sign and date the document in Part I, items 7)8 and complete item
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
bsaefiling.fincentreas.gov/main.html for registration). Read and complete the account owner statement in Part I. To authorize a third party to file the Foreign Bank and Financial Accounts Report (FBAR), the account owner should complete Part I. items 1 through 3 (as required), sign and date the document in Part I. items 7/8 and complete item
Entities connected to both the U.S. Treasury Financial Agent and the Foreign Bank and Financial Accounts Report

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
PERSONFBAR S gnature
ORGANIZATIONForeign Bank
ORGANIZATIONBSA Efiling
ORGANIZATIONConservation Reserve Program
ORGANIZATIONConservation Reserve
ORGANIZATIONJohn O. Smith
PERSONthe New York State Tax Department
ORGANIZATION