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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
you (or an entity of which you are an owner) been convicted of Bribery Involving Public Servants and Related Offenses, Corrupting the Government, or Defrauding the Government (NYS Penal Law Article 200. 496. or section 195.20)? (see instructions) Your social secumy number Part 1 - 0 her New York State, New York City, an
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
you (or an entity of which you are an owner) been convicted of Bribery Involving Public Servants and Related Offenses, Corrupting the Government, or Defrauding the Government (NYS Penal Law Article 200. 496. or section 195.20)? (see instructions) Part 1 - O her New York State, New York City, and Yonkers ax credits Secti
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,
you (or an entity of which you are an owner) been convicted of Bribery Involving Public Servants and Related Offenses, Corrupting the Government, or Defrauding the Government (NYS Penal Law Article 200, 496. or section 195.20)? (see instructions) Department of Taxation and Finance Other Tax Credits and Taxes Attachment
Entities connected to both Spouse and Defrauding the Government

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