3
Shared Docs
3
Same-Page
3 / 3
Mentions
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
ve proper credit, you must enter your correct Social Security Number or Employer Identification Number on your declaration and remittance. DETACH ON DOTTED LINE & MAIL UPPER PORTION. RETAIN LOWER PORTION FOR YOUR RECORDS 05 ESTIMATED TAX WORKSHEET • KEEP THIS PORTION FOR YOUR RECORDS • 1. Net income from business expected in
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
ve proper credit, you must enter your correct Social Security Number or Employer Identification Number on your declaration and remittance. DETACH ON DOTTED LINE & MAIL UPPER PORTION. RETAIN LOWER PORTION FOR YOUR RECORDS 05 11. ESTIMATED TAX WORKSHEET • KEEP THIS PORTION FOR YOUR RECORDS • 1. Net income from business expect
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,
ve proper credit, you must enter your correct Social Security Number or Employer Identification Number on your declaration and remittance. DETACH ON DOTTED LINE & MAIL UPPER PORTION. RETAIN LOWER PORTION FOR YOUR RECORDS 05 ESTIMATED TAX WORKSHEET • KEEP THIS PORTION FOR YOUR RECORDS • 1. Net income from business expected in
Entities connected to both Spouse and DOTTED LINE & MAIL UPPER PORTION

Joi Ito
PERSON
New York City
LOCATION
United States
LOCATION
New York
LOCATION
George W. Bush
PERSON
NEW YORK NY
LOCATION
U.S. Treasury
ORGANIZATIONMaria Farmer
PERSONPreparer
ORGANIZATIONthe New York State Tax Department
ORGANIZATIONUtilities
ORGANIZATIONFiler
PERSONERO Signature
ORGANIZATIONthe New York State Department of Taxation and Finance
ORGANIZATIONBusiness Tax Credit
ORGANIZATIONSchedule SE
PERSONthe Commercial Rent Tax Return
ORGANIZATIONthe Foreign Earned Income Tax Worksheet
ORGANIZATIONNew York State Sales Tax
ORGANIZATIONPersonal Income Tax Information Center
ORGANIZATION