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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
Stop: enter line 11 amount on Form IT205, line 22 New York City full-year resident Individuals 12 Amount from Form IT•201. fine 49 13 Amount from Form IT-20VATT, line 32 14 Amount from Form IT-20VATT, line 33 15 Add lines 12. 13, and 14 16 Enter the lesser of line 11 or 15, and transfer the amount to Form
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
top: enter line 11 amount on Form IT-205, line 22 New York City full-year resident individuals 12 Amount from Form fT•201. line 49 13 Amount from Form IT-20VATT, line 32 14 Amount from Form IT-20VATT, line 33 15 Add lines 12. 13. and 14 16 Enter the lesser of line 11 or 15, and transfer the amount to Form
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,
line 22 New York City full-year resident Individuals 12 Amount from Form IT•201. line 49 13 Amount from Form IT-201401T, line 32 14 Amount from Form IT-20VATT, line 33 15 Add Ines 12. 13. and 14 16 Enter the lesser of line 11 or 15, and transfer the amount to Form If-201•ATT, line 8 219001171019 III I
Entities connected to both Spouse and Form IT-20VATT

New York City
LOCATION
United States
LOCATION
Joi Ito
PERSON
New York
LOCATION
U.S. Treasury
ORGANIZATION
NEW YORK NY
LOCATIONUtilities
ORGANIZATIONERO Signature
ORGANIZATIONC-EZ
ORGANIZATIONPreparer
ORGANIZATIONthe U.S. Treasury Financial Agent
ORGANIZATIONSchedule SE
PERSON
FinCEN
ORGANIZATIONMaria Farmer
PERSONFiler
PERSONthe Foreign Earned Income Tax Worksheet
ORGANIZATIONBSA Efiling
ORGANIZATIONTHE NY TAX DEPT
ORGANIZATIONPersonal Income Tax Information Center
ORGANIZATION
Empire State
LOCATION