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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
2. Exemption (see instructions) 3. Line 1 less line 2 (estimated taxable business income) 4. Tax • enter 4% of line 3(see instructions) 5a. Business Tax Credit (00 ) (Check applicable box below and enter credit amount) Tax on line 4 is $3,400 or less. Your credit is the entire amount of tax on line 4. Tax
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
ORDS • 1. Net income from business expected in 2018 (see instructions) 1. 2. 3. 4. Tax • enter 4% of line 3(see Instructions) 4, 5a. Business Tax Credit (00 ) (Check applicable box below and enter credit amount) Tax on line 4 is $3,400 or less. Your credit is the entire amount of tax on line 4. Tax
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,
2. Exemption (see instructions) 3. Line 1 less line 2 (estimated taxable business income) 4. Tax • enter 4% of line 3(see instructions) 5a. Business Tax Credit (00 ) (Check applicable box below and enter credit amount) Tax on line 4 is $3,400 or less. Your credit is the entire amount of tax on line 4. Tax
Entities connected to both Spouse and Business Tax Credit

Joi Ito
PERSON
New York City
LOCATION
United States
LOCATION
New York
LOCATION
George W. Bush
PERSON
U.S. Treasury
ORGANIZATION
NEW YORK NY
LOCATIONMaria Farmer
PERSONUtilities
ORGANIZATIONFiler
PERSON
FinCEN
ORGANIZATIONthe U.S. Treasury Financial Agent
ORGANIZATIONthe New York State Tax Department
ORGANIZATIONPreparer
ORGANIZATIONDOTTED LINE & MAIL UPPER PORTION
ORGANIZATIONSchedule SE
PERSONC-EZ
ORGANIZATIONthe Foreign Earned Income Tax Worksheet
ORGANIZATIONERO Signature
ORGANIZATIONYonkers
LOCATION