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
ticobl Dependents on 6c not entered above Add Nantes on lines., 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
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
oduction activities deduction. Attach Form 8903 36 Add lines 23 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
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
e 8a - Ordinary dividends. Attach Schedule B d required- Qualified 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
Entities connected to both the U.S. Treasury Financial Agent and Alimony

U.S. Treasury
ORGANIZATIONSchedule SE
PERSONthe Foreign Earned Income Tax Worksheet
ORGANIZATIONC-EZ
ORGANIZATION
United States
LOCATIONERO Signature
ORGANIZATIONSpouse
ORGANIZATIONUtilities
ORGANIZATIONConservation Reserve
ORGANIZATION
Joi Ito
PERSONJurat/Disclosure
ORGANIZATIONConservation Reserve Program
ORGANIZATIONFiler
PERSON
FinCEN
ORGANIZATIONApplication for Automatic Extension of Time
ORGANIZATIONthe Foreign Bank and Financial Accounts Report
ORGANIZATIONForeign Bank
ORGANIZATIONBSA Efiling
ORGANIZATIONPreparer
ORGANIZATIONPersonal Income Tax Information Center
ORGANIZATION