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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
the best of my knowledge and belief. it is true. correct, and complete. This declaration is based on all information of which I have any knowledge. ERO Signature I am signing this Tax Return by entering my PIN below. ERO's PIN (enter EFIN plus 5 sell-selected numerics) Taxpayer Declarations Perjury Statem
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
the best of my knowledge and belief. it is true, correct. and complete. This declaration is based on all information of which I have any knowledge. ERO Signature I am signing this Tax Return by entering my PIN below. ERO's PIN (enter EFIN plus 5 self-selected numerics) Taxpayer Declarations Perjury Statem
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
the best of my knowledge and belief. it is true. correct. and complete. This declaration is based on all information of which I have any knowledge. ERO Signature I am signing this Tax Return by entering my PIN below. ERO's PIN 13769913349 (enter EFIN plus 5 self-selected numerics) Taxpayer Declarations P
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Mutual Connections (109)
Entities connected to both BSA Efiling and ERO Signature
U.S. Treasury
ORGANIZATION4 w/ BSA·5 w/ ERO
Spouse
ORGANIZATION4 w/ BSA·5 w/ ERO
C-EZ
ORGANIZATION3 w/ BSA·5 w/ ERO
the U.S. Treasury Financial Agent
ORGANIZATION3 w/ BSA·5 w/ ERO
United States
LOCATION3 w/ BSA·5 w/ ERO
SS
Schedule SE
PERSON3 w/ BSA·5 w/ ERO
FinCEN
ORGANIZATION4 w/ BSA·4 w/ ERO
the Foreign Earned Income Tax Worksheet
ORGANIZATION3 w/ BSA·5 w/ ERO
FI
Filer
PERSON4 w/ BSA·4 w/ ERO
Conservation Reserve
ORGANIZATION3 w/ BSA·4 w/ ERO
Jurat/Disclosure
ORGANIZATION3 w/ BSA·4 w/ ERO
the Foreign Bank and Financial Accounts Report
ORGANIZATION4 w/ BSA·3 w/ ERO
Foreign Bank
ORGANIZATION4 w/ BSA·3 w/ ERO
Utilities
ORGANIZATION3 w/ BSA·4 w/ ERO
Joi Ito
PERSON3 w/ BSA·4 w/ ERO
Conservation Reserve Program
ORGANIZATION3 w/ BSA·4 w/ ERO
FBAR S gnature
ORGANIZATION4 w/ BSA·3 w/ ERO
Preparer
ORGANIZATION4 w/ BSA·3 w/ ERO
JS
John O. Smith
PERSON3 w/ BSA·3 w/ ERO
the New York State Tax Department
ORGANIZATION3 w/ BSA·3 w/ ERO