3
Shared Docs
3
Same-Page
3 / 3
Mentions
lost (Replacement requested) Late receiving missing required account information Unable to obtain joint spouse signature in time Unable to access BSA Efiling system Other (please provide explanation below) 773151 05-21-17 EFTA00792088 FinCEN Form 114 REPORT OF FOREIGN BANK AND FINANCIAL ACCOUNTS Do
above P"' Taxable refunds, credits, or offsets of state and local income taxes Alimony received Business income or (loss). Attach Schedule C or C-EZ Capital gain or (loss). Attach Schedule D if required. If not required, check here ► 7 8a 740. 9a 10 11 12 13 14 15b 16b 17 18 19
lost (Replacement requested) Late receiving missing required account information Unable to obtain joint spouse signature in time Unable to access BSA Efiling system Other (please provide explanation below) 773151 05-21-17 EFTA00792178 FinCEN Form 114 REPORT OF FOREIGN BANK AND FINANCIAL ACCOUNTS Do
through 35 Taxable refunds, credits, or offsets of state and local income taxes Alimony received Business income or (loss). Attach Schedule C or C-EZ ► 7 8a 755. 9a 10 11 12 13 14 15b 16b 17 18 19 20b 21 22 1,645,828. ► 1,646,583. Adjusted Gross Income 23 24 25 26 2
lost (Replacement requested) Late receiving missing required account information Unable to obtain joint spouse signature in time Unable to access BSA Efiling system Other (please provide explanation below) 773151 05-21-17 EFTA00792000 FinCEN Form 114 REPORT OF FOREIGN BANK AND FINANCIAL ACCOUNTS Do
ets of state and local income taxes 10 1099-R if tax was withheld. 11 Alimony received 11 12 Business income or (loss). Attach Schedule C or C-EZ 12 13 Capital gain or (loss). Attach Schedule D U required. If not required, ohm* here 13 If you did not get a W-2, 14 Other gains or (los
Entities connected to both BSA Efiling and C-EZ
Spouse
ORGANIZATION
U.S. Treasury
ORGANIZATIONthe U.S. Treasury Financial Agent
ORGANIZATION
United States
LOCATIONSchedule SE
PERSON
FinCEN
ORGANIZATIONthe Foreign Earned Income Tax Worksheet
ORGANIZATIONFiler
PERSONERO Signature
ORGANIZATIONJurat/Disclosure
ORGANIZATIONthe Foreign Bank and Financial Accounts Report
ORGANIZATIONForeign Bank
ORGANIZATIONUtilities
ORGANIZATION
Joi Ito
PERSONConservation Reserve Program
ORGANIZATIONFBAR S gnature
ORGANIZATIONPreparer
ORGANIZATIONConservation Reserve
ORGANIZATIONJohn O. Smith
PERSONthe New York State Tax Department
ORGANIZATION