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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
5 • June 15 = (61 365) x 7.5% = .01253 - Or - April 15 l* 365)x 7.5%= • 32 Multiply line 30. column A by line 31 30 31 32 2965.00 37 oc. Second Installment (June 15 - September 15, 20 7) 33 June 15 • September 15 = (92 365) x 7.5% = .01890 June 15. =( 365) x 7.5% = 34 Multiply line 30. column 8 by l
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
5 • June 15 = (61 365) x 7.5% = .01253 - Or - April 15 l* 365)x 7.5%= • 32 Multiply line 30. column A by line 31 30 31 32 2965.00 37 oc. Second Installment (June 15 - September 15, 20 7) 33 June 15 • September 15 = (92 365) x 7.5% = .01890 June 15. =( 365) x 7.5% = 34 Multiply line 30. column 8 by l
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,
5 • June 15 = (61 365) x 7.5% = .01253 - or - April 15 • It365)x 7.5%. • 32 Multiply line 30. column A by line 31 30 31 32 1111 co 14 cc Second Installment (June 16 - September 15, 20 7) 33 June 15 September 15 = (92 + 365) x 7.5% = .01890 June 15. =( + 365) x 7.5% = • 34 Multiply line 30, column B
Entities connected to both Spouse and Second Installment

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