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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
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
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
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
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
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 the U.S. Treasury Financial Agent and Foreign Bank

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
ORGANIZATIONthe Foreign Bank and Financial Accounts Report
ORGANIZATIONBSA Efiling
ORGANIZATIONConservation Reserve Program
ORGANIZATIONConservation Reserve
ORGANIZATIONJohn O. Smith
PERSONthe New York State Tax Department
ORGANIZATION