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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
$ 0 SEPTEMBER 17, 2018 No. 4 $ 0 JANUARY 15, 2019 Make check payable to UNITED STATES TREASURY Mail voucher and check (if applicable) to INTERNAL REVENUE SERVICE CENTER P.O. BOX 37007 HARTFORD, CT 06176-7007 Special Instructions INCLUDE YOUR SOCIAL SECURITY NUMBER AND THE 1040-ES" ON YOUR CHECK. VOUCHERS NEED
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
SEPTEMBER 17, 2018 No. 4 $ 443,400 JANUARY 15, 2019 Make check payable to UNITED STATES TREASURY Mail voucher and check (if applicable) to INTERNAL REVENUE SERVICE CENTER P.O. BOX 37007 HARTFORD, CT 06176-7007 Special Instructions INCLUDE YOUR SOCIAL SECURITY NUMBER AND THE 1040-ES" ON YOUR CHECK. VOUCHERS NEED
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,
S TREASURY. INCLUDE YOUR SOCIAL SECURITY NUMBER, DAYTIME PHONE NUMBER, AND THE WORDS "2017 FORM 4868" ON YOUR CHECK. MAIL AS SOON AS POSSIBLE TO: INTERNAL REVENUE SERVICE CENTER III. BOX 37009 HARTFORD, CT 06176-7009 718711 06.15.17 • DETACH HERE • 4868 Department Otte, Traaluy Intornal Inryinnun Snrvictr Fix Cale A
Entities connected to both Spouse and INTERNAL REVENUE SERVICE CENTER

United States
LOCATION
George W. Bush
PERSON
New York City
LOCATION
Joi Ito
PERSON
New York
LOCATION
U.S. Treasury
ORGANIZATION
NEW YORK NY
LOCATIONSchedule SE
PERSON
New York State
LOCATIONMaria Farmer
PERSONYonkers
LOCATIONUtilities
ORGANIZATION
FinCEN
ORGANIZATIONthe Foreign Earned Income Tax Worksheet
ORGANIZATIONC-EZ
ORGANIZATIONPreparer
ORGANIZATIONNY State
ORGANIZATIONERO Signature
ORGANIZATIONFiler
PERSONthe U.S. Treasury Financial Agent
ORGANIZATION