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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
unknown 16 Type of account aLLI Bank bLJ Securities cl I Other Enter type below Lai 17 Name of financial institution in which account is held UNICREDIT BANK AUSTRIA AG 18 Account number i nation ******** 19 Mailing address (number, street, apt. or suite no.) of financial institution in which account is held SCH
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
own 16 Type of account aLLI Bank bU Securities cl I Other Enter type below 11,781. Li 17 Name of financial institution In which account is held UNICREDIT BANK AUSTRIA AG 18 Account number or other designation *********6463 19 Mailing address (number, street, apt. or suite no.) of financial institution in which acco
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,
nown 16 Type of account aLXJ Bank bU Securities cl I Other Enter type below 11,781. Li 17 Name of financial institution In which account is held UNICREDIT BANK AUSTRIA AG 18 Account number or other designation *********6463 19 Mailing address (number, street, apt. or suite no.) of financial institution in which acco
Entities connected to both Spouse and UNICREDIT BANK AUSTRIA AG

Joi Ito
PERSON
New York City
LOCATION
United States
LOCATION
New York
LOCATION
NEW YORK NY
LOCATION
U.S. Treasury
ORGANIZATIONUtilities
ORGANIZATIONthe Foreign Earned Income Tax Worksheet
ORGANIZATION
FinCEN
ORGANIZATIONERO Signature
ORGANIZATIONPreparer
ORGANIZATIONC-EZ
ORGANIZATIONthe U.S. Treasury Financial Agent
ORGANIZATIONSchedule SE
PERSONMaria Farmer
PERSONFiler
PERSONBSA Efiling
ORGANIZATIONNYC-210
ORGANIZATIONPersonal Income Tax Information Center
ORGANIZATION
Empire State
LOCATION