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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
he following amount for your filing status: Married filing jointly $250,000 Married filing separately $125,000 Single, Head of household, or Qualifying widow(er) $200,000 5 6 Subtract line 5 from line 4. If zero or less. enter 0- 6 7 Additional Medicare Tax on Medicare wages. Multiply line 6 by 0.9% (0.0
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
he following amount for your filing status: Married filing jointly $250,000 Married filing separately $125,000 Single, Head of household, or Qualifying widow(er) $200,000 9 200,000. 10 Enter the amount from line 4 10 11 Subtract line 10 from line 9. If zero or less. enter .0- 11 200,000. 12 Subtract
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,
he following amount for your filing status: Married filing jointly $250,000 Married filing separately $125,000 Single. Head of household, or Qualifying widow(er) $200,000 9 200,000. 10 Enter the amount from line 4 10 11 Subtract line 10 from line 9. If zero or less. enter .0- 11 200,000. 12 Subtract
Entities connected to both Spouse and Qualifying widow(er

Joi Ito
PERSON
United States
LOCATION
New York City
LOCATION
New York
LOCATION
U.S. Treasury
ORGANIZATION
NEW YORK NY
LOCATIONUtilities
ORGANIZATIONSchedule SE
PERSONthe Foreign Earned Income Tax Worksheet
ORGANIZATIONERO Signature
ORGANIZATIONConservation Reserve Program
ORGANIZATIONPreparer
ORGANIZATION
FinCEN
ORGANIZATIONConservation Reserve
ORGANIZATIONC-EZ
ORGANIZATIONMaria Farmer
PERSONFiler
PERSONthe U.S. Treasury Financial Agent
ORGANIZATIONFBAR S gnature
ORGANIZATIONYonkers
LOCATION