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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
dicated on my 2017 electronic return, and authorized the financial institution to withdraw the amount from that account As New York does not support International ACH Transactions (IAT), I attest the source for these funds is within the United States. I understand and agree that I may revoke this authorization for payment only
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,
dicated on my 2017 electronic return, and authorized the financial institution to withdraw the amount from that account As New York does not support International ACH Transactions (IAT), I attest the source for these funds is within the United States. I understand and agree that I may revoke this authorization for payment only
y Tax Credit, or Ny0210, Claim for New York City School Tax Credit. For returns filed jointly, both spouses must complete and sign Form TR-5791T. Spouse's name: (Jointly filed return only) 588351 11.2545 EROs must complete Part C prior to transmitting electronically filed income tax returns (Forms
indicated on my 2015 electronic return, and I authorize my financial institution to withdraw the amount from my account As New York does not support International ACH Transactions (IAT), I attest the source for these funds is within the United States. I understand and agree that I may revoke this authorization for payment only
Entities connected to both Spouse and International ACH Transactions

New York City
LOCATION
Joi Ito
PERSON
New York
LOCATION
United States
LOCATION
George W. Bush
PERSON
NEW YORK NY
LOCATION
U.S. Treasury
ORGANIZATIONMaria Farmer
PERSONthe New York State Tax Department
ORGANIZATIONUtilities
ORGANIZATIONPersonal Income Tax Information Center
ORGANIZATION
New York State
LOCATIONPreparer
ORGANIZATIONYonkers
LOCATIONFiler
PERSONFirst Installment
ORGANIZATIONTHE NY TAX DEPT
ORGANIZATIONNYC-210
ORGANIZATIONDOTTED LINE & MAIL UPPER PORTION
ORGANIZATION
FinCEN
ORGANIZATION