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gning this Tax Return and Electronic Funds Withdrawal Consent, it applicable, by entering my Self-Select PIN below. Taxpayer's PIN: Date 09122018 Spouse's PIN: 719986 044)I.17 EFTA00792091 Form 114a Department of the Treasury Financial Crimes Enforcement Network (FinCEN) May 2015 Record of Au
xable year, state date terminated. (mmddiry) (Attach a statement showing disposition of business property.) 6. Has the Internal Revenue Service or the New York State Department of Taxation and Finance Increased or decreased any taxable Income (loss) reported in any tax period, or are you currently being audited?,„ YES X NO If 'YES', by whom? I
Information. 2017 Submission Identification Number (SID) Taxpayer's name ANASTASIYA SIROOCHENKO Social security number ***4**4. Spouses name Spouse's social secure num er . . liPart rl Tax Return Information - Tax Year Ending December 31, 2017 (Whole dollars only) 1 Adjusted gross income (F
t taxable year, state date terminated. (mmddly) (Attach a statement showing disposition of business property.) Has the Internal Revenue Service or the New York State Department of Taxation and Finance Increased or decreased any taxable Income (loss) reported in any tax period, or are you currently being audited?. YES X NO If 'YES", by whom? In
ormation. 2017 Submission Identification Number (SID) Taxpayer's name ANASTASIYA SIROOCHENKO Spouses name Social security number ***4 "4-9816 Spouse's social security number IPartI Tax Return Information - Tax Year Ending December 31,2017 (whole dollars only) 1 Adjusted gross income (Form 1040,
t taxable year, state date terminated. (mmddly) (Attach a statement showing disposition of business property.) Has the Internal Revenue Service or the New York State Department of Taxation and Finance increased or decreased any taxable income (loss) reported in any tax period, or are you currently being audited?. YES X NO If 'YES", by whom? In
Entities connected to both Spouse and the New York State Department of Taxation and Finance

Joi Ito
PERSON
New York City
LOCATION
New York
LOCATION
United States
LOCATION
George W. Bush
PERSON
NEW YORK NY
LOCATION
the Internal Revenue Service
ORGANIZATION
U.S. Treasury
ORGANIZATION
New York State
LOCATIONMaria Farmer
PERSONPreparer
ORGANIZATIONYonkers
LOCATIONUtilities
ORGANIZATIONthe Foreign Earned Income Tax Worksheet
ORGANIZATIONthe Commercial Rent Tax Return
ORGANIZATIONNY State
ORGANIZATIONSchedule SE
PERSONthe U.S. Treasury Financial Agent
ORGANIZATIONERO Signature
ORGANIZATIONthe New York State Tax Department
ORGANIZATION