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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
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
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
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
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
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
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 cancellati
STMT 3 $TMT 5 10 0. 1099-R if tax was withheld. 11 Alimony received 11 12 -99,490. 12 Business income or (loss). Attach Schedule C or C-EZ If you did not get a W-2, see instructions. 13 14 15a Capital gain or (loss). Attach Schedu Other gains or (losses). Attach Form IRA distri
imated 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 cancellati
dividends 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 Other gains or (losses). Attach Form 4797 IRA distnbutians
Entities connected to both the U.S. Treasury Financial Agent and C-EZ

U.S. Treasury
ORGANIZATIONERO Signature
ORGANIZATIONSchedule SE
PERSON
United States
LOCATIONSpouse
ORGANIZATIONthe Foreign Earned Income Tax Worksheet
ORGANIZATIONJurat/Disclosure
ORGANIZATIONConservation Reserve Program
ORGANIZATIONUtilities
ORGANIZATION
FinCEN
ORGANIZATIONConservation Reserve
ORGANIZATION
Joi Ito
PERSONFiler
PERSONWomen's Cancers Education and Prevention Fund
ORGANIZATIONVeterans'
ORGANIZATIONBribery Involving Public Servants
ORGANIZATIONDefrauding the Government
ORGANIZATIONTotal New York State
ORGANIZATIONWorksheet A
ORGANIZATIONForm IT-20VATT
ORGANIZATION