3
Shared Docs
3
Same-Page
3 / 3
Mentions
saction. If I am paying my New York State personal income taxes due by electronic funds withdrawal, I certify that the account holder has authorized the New York State Tax Department and its designated financial agents to initiate an electronic funds withdrawal from the financial institution account indicated on my 2017 electroni
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
saction. If I am paying my New York State personal income taxes due by electronic funds withdrawal, I certify that the account holder has authorized the New York State Tax Department and its designated financial agents to initiate an electronic funds withdrawal from the financial institution account indicated on my 2017 electroni
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
saction. If I am paying my New York State personal income taxes due by electronic funds withdrawal, I certify that the account holder has authorized the New York State Tax Department and its designated financial agents to initiate an electronic funds withdrawal from the financial institution account indicated on my 2017 electroni
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 the New York State Tax Department and Defrauding the Government

New York State
LOCATIONPreparer
ORGANIZATIONPersonal Income Tax Information Center
ORGANIZATION
NEW YORK NY
LOCATIONDOTTED LINE & MAIL UPPER PORTION
ORGANIZATIONNew York State Sales Tax
ORGANIZATION
New York
LOCATION
United States
LOCATIONYonkers
LOCATIONMaria Farmer
PERSONBusiness Tax Credit
ORGANIZATIONForm NYC-
LOCATION
the Internal Revenue Service
ORGANIZATIONNYC-210
ORGANIZATIONTHE NY TAX DEPT
ORGANIZATIONNY State
ORGANIZATIONInternational ACH Transactions
ORGANIZATION
Empire State
LOCATION
New York City
LOCATIONBreast Cancer Research Fund
ORGANIZATION