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
individual: Enter the amount from Form NYC-202. line 21, or Form NYC.202S. line 8 (see inStr.) Part-year resident Individual: Enter the amount from Worksheet A, line 5 (on page 2) 8 65206.00 Part 3 - Beneficiary's share of unincorporated business taxes(see Instructions) 7 Beneficiary - Enter your share o
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
individual: Enter the amount from Form NYC-202, line 21, or Form NYC-2025. line 8 (see Instr.) Part-year resident Individual: Enter the amount from Worksheet A, line 5 (on page 2) 65233.00 Part 3 - Beneficiary's share of unincorporated business taxes(soe Instructions) 7 Beneficiary - Enter your share of
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
individual: Enter the amount from Form NYC-202. line 21, or Form NYC.202S. Lie 8 (see friStr.) Part-year resident Individual: Enter the amount from Worksheet A, line 5 (on page 2) el 65115.00 Part 3 - Beneficiary's share of unincorporated business taxes (see Instructions) 7 Beneficiary - Enter your share
Entities connected to both the U.S. Treasury Financial Agent and Worksheet A

U.S. Treasury
ORGANIZATIONSpouse
ORGANIZATIONthe Foreign Earned Income Tax Worksheet
ORGANIZATIONSchedule SE
PERSONC-EZ
ORGANIZATION
United States
LOCATIONERO Signature
ORGANIZATIONFiler
PERSONConservation Reserve
ORGANIZATIONConservation Reserve Program
ORGANIZATIONUtilities
ORGANIZATIONJurat/Disclosure
ORGANIZATION
FinCEN
ORGANIZATION
New York State
LOCATION
Empire State
LOCATIONthe Dept. of Finance
ORGANIZATIONTaxpayer for Forms NYC-202, NYC-202S
ORGANIZATIONJohn O. Smith
PERSONthe New York State Tax Department
ORGANIZATIONWomen's Cancers Education and Prevention Fund
ORGANIZATION