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ealth Education 60i .00 60) Veterans Remembrance 60) .00 60k Homeless Veterans 60k .00 601 Mental Illness AntiStigrna Fund 601 .00 60m Women's Cancers Education and Prevention Fund 60m .00 60n Autism Fund 60n .00 60o Veterans' Homes 60o .00 60 Total voluntary contributions (add tines 60a through 60o) 61 Total New Y
1615964 0 1. 2. 3. 4. 5. Part B Declaration of taxpayer and authorizations for Forms IT-201, IT-201-X, IT-203, IT-203-X, IT-214, NYC-208, and NYC-210 Under penalty of perjury, I declare that I have examined the information on my 2017 New York State electronic personal income tax return, including
ealth Education 60i .00 60) Veterans Remembrance 60) .00 60k Homeless Veterans 60k .00 601 Mental Illness Anti-Stigma Fund 601 .00 60m Women's Cancers Education and Prevention Fund 60m .00 60n Autism Fund 60n .00 60o Veterans' Homes 60o .00 60 Total voluntary contributions (add tines 60a through 60o) 61 Total New Y
1616657 0 1. 2. 3. 4. 5. Part B Declaration of taxpayer and authorizations for Forms IT-201, IT-201-X, IT-203, IT-203-X, IT-214, NYC-208, and NYC-210 Under penalty of perjury, I declare that I have examined the information on my 2017 New York State electronic personal income tax return, including
ealth Education 60i .00 60) Veterans Remembrance 60) .00 60k Homeless Veterans 60k .00 60I Mental Illness Anti-Stigma Fund 601 .00 60m Women's Cancers Education and Prevention Fund 60m .00 60n Autism Fund 60n .00 60o Veterans' Homes 60o 00 60 Total voluntary contributions (add fines 60a through 60o) 61 Total Now Yo
1540837 0 1. 2. 3. 4. 5. Part B Declaration of taxpayer and authorizations for Forms IT-201, IT-201-X, IT-203, IT-203-X, IT-214, NYC-208, and NYC-210 Under penalty of perjury, I declare that I have examined the information on my 2017 New York State electronic personal income tax return, including
en Hearth Education 60i 00 60) Veterans Remembrance 60) 00 60k Homeless Veterans 60k 00 601 Mental Illness AntiStigrna Fund 601 00 60m Women's Cancers Education and Prevention Fund 60m 00 60 Total voluntary contributions (add fines 60a through 60m) too 61 Total New York State, New York City, Yonkers, and sales or use taxe
EROs must complete Part C prior to transmitting electronically filed income tax returns (Forms IT-201, 11-201-X. IT-203, IT-20&X.17214, NYC-208, and NYC-210). Both the paid preparer and the ERO are required to sign Part C. However, if an individual performs as both the paid preparer and the ERO, he or
Entities connected to both Women's Cancers Education and Prevention Fund and NYC-210
Spouse
ORGANIZATION
Empire State
LOCATIONthe New York State Tax Department
ORGANIZATIONBreast Cancer Research Fund
ORGANIZATIONPersonal Income Tax Information Center
ORGANIZATIONNY City
LOCATION
New York
LOCATIONFirst Installment
ORGANIZATIONTHE NY TAX DEPT
ORGANIZATIONYonkers
LOCATIONNY State
ORGANIZATION
New York State
LOCATIONConservation Reserve Program
ORGANIZATIONthe Dept. of Finance
ORGANIZATIONTaxpayer for Forms NYC-202, NYC-202S
ORGANIZATIONJohn O. Smith
PERSONthe New York State Department of Taxation and Finance
ORGANIZATIONWEISS
ORGANIZATION
York City
LOCATIONFBAR S gnature
ORGANIZATION