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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
2 Total tax (Form 1040, line 63; Form 1040A. line 39; Form 1040EZ, line 12; Form 1040NR. line 61) 2 584,587. 3 Federal income tax withheld from Forms W2 and 1099 (Form 1040, line 64; RIM 1040A, line 40; Form 1040EZ. line 7; Form 1040NR, lie 62a) 4 Refund (Form 1040, line 76a; Form 1040A. line 48a;
2 mentions1 same-page
Page ?Same page
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
2 Total tax (Form 1040. line 63; Form 1040A, line 39; Form 1040EZ, line 12; Form 1040NR, line 61) 2 584,894. 3 Federal income tax withheld from Forms W2 and 1099 (Form 1040• line 64; Form 1040A, line 40; Form 1040€2, line 7; Form 104014R, line 62a) 4 Refund (Form 1040, line 76a; Form 1040A, line 48
2 mentions1 same-page
Page ?Same page
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
2 Total tax (Form 1040. line 63; Form 1040A, line 39; Form 1040EZ, line 12; Form 1040NR, line 61) 2 556,671. 3 Federal income tax withheld from Forms W2 and 1099 (Form 1040, line 64; Ft:10111040A, line 40; Form 1040EZ, line 7; Form 104014R, line 62a) 4 Refund (Form 1040, line 76a; Form 1040A, line
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Entities connected to both BSA Efiling and Forms W2
U.S. Treasury
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FBAR S gnature
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the Foreign Bank and Financial Accounts Report
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Foreign Bank
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Preparer
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FI
Filer
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Spouse
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FinCEN
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NEW YORK NY
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the Dept. of Finance
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U.B.T.
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New York
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NY State
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New York State
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Empire State
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the U.S. Treasury Financial Agent
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Conservation Reserve Program
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the New York State Tax Department
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Women's Cancers Education and Prevention Fund
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NY City
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