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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
o the best of my knowledge and belief, the return is true, correct, and complete. I have based this declaration on all information available to me. ERO EFIN/PIN: Enter your sixdigit EFIN followed by your five digit PIN: DAVID WEISS CPA, PLLC DAVID WEISS CPA, PLLC ERO's Signature Print Name Date DAVID WE
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
the paper return. If I am the paid preparer, filed unincorporated business tax return or other based this declaration on all information available ERO EFIN/PIN: Enter your six•cligit EFIN followed DAVID WEISS CPA, PLLC contained in the above named taxpayers 2017 New York City electronically filed checked
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,
the paper return. If I am the paid preparer, filed unincorporated business tax return or other based this declaration on all information available ERO EFIN/PIN: Enter your six-digit EFIN followed DAVID WEISS CPA, PLLC contained in the abovenamed taxpayers 2017 New York City electronically filed checked ab
Entities connected to both Spouse and ERO EFIN/PIN

Joi Ito
PERSON
New York City
LOCATION
United States
LOCATION
New York
LOCATION
NEW YORK NY
LOCATION
George W. Bush
PERSON
U.S. Treasury
ORGANIZATIONMaria Farmer
PERSONUtilities
ORGANIZATIONPreparer
ORGANIZATIONthe New York State Tax Department
ORGANIZATIONthe Foreign Earned Income Tax Worksheet
ORGANIZATION
FinCEN
ORGANIZATIONPersonal Income Tax Information Center
ORGANIZATIONC-EZ
ORGANIZATIONSchedule SE
PERSONERO Signature
ORGANIZATION
New York State
LOCATIONFiler
PERSONthe U.S. Treasury Financial Agent
ORGANIZATION