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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 Total tax (Form 1040, line 63; Form 1040A. line 39; Form 1040EZ, line 12; Form 1040NR. line 61) 2 584,587. 3 Federal income tax withheld from Forms W2 and 1099 (Form 1040, line 64; RIM 1040A, line 40; Form 1040EZ. line 7; Form 1040NR, lie 62a) 4 Refund (Form 1040, line 76a; Form 1040A. line 48a;
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
2 Total tax (Form 1040. line 63; Form 1040A, line 39; Form 1040EZ, line 12; Form 1040NR, line 61) 2 584,894. 3 Federal income tax withheld from Forms W2 and 1099 (Form 1040• line 64; Form 1040A, line 40; Form 1040€2, line 7; Form 104014R, line 62a) 4 Refund (Form 1040, line 76a; Form 1040A, line 48
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 Total tax (Form 1040. line 63; Form 1040A, line 39; Form 1040EZ, line 12; Form 1040NR, line 61) 2 556,671. 3 Federal income tax withheld from Forms W2 and 1099 (Form 1040, line 64; Ft:10111040A, line 40; Form 1040EZ, line 7; Form 104014R, line 62a) 4 Refund (Form 1040, line 76a; Form 1040A, line
Entities connected to both Spouse and Forms W2

New York City
LOCATION
United States
LOCATION
Joi Ito
PERSON
New York
LOCATION
U.S. Treasury
ORGANIZATION
NEW YORK NY
LOCATIONUtilities
ORGANIZATIONMaria Farmer
PERSONFiler
PERSON
FinCEN
ORGANIZATIONthe U.S. Treasury Financial Agent
ORGANIZATIONPreparer
ORGANIZATIONSchedule SE
PERSONC-EZ
ORGANIZATIONthe Foreign Earned Income Tax Worksheet
ORGANIZATIONERO Signature
ORGANIZATIONYonkers
LOCATIONNY State
ORGANIZATION
New York State
LOCATION
Empire State
LOCATION