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
ake sure that your name is spelled correctly. You should enter your first name, middle initial, then last name in the spaces provided (for example, John O. Smith). Your name must agree with the name on your New York State income tax return. • Foreign addresses - Enter the information in the following order:
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
ake sure that your name is spelled correctly. You should enter your first name, middle initial, then last name in the spaces provided (for example, John O. Smith). Your name must agree with the name on your New York State income tax return. • Foreign addresses - Enter the information in the following order:
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
ake sure that your name is spelled correctly. You should enter your first name, middle initial, then last name in the spaces provided (for example, John O. Smith). Your name must agree with the name on your New York State income tax return. • Foreign addresses - Enter the information in the following order:
Entities connected to both the New York State Tax Department and John O. Smith

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