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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
individual: Enter the amount from Form NYC-202. line 21, or Form NYC.202S. line 8 (see inStr.) Part-year resident Individual: Enter the amount from Worksheet A, line 5 (on page 2) 8 65206.00 Part 3 - Beneficiary's share of unincorporated business taxes(see Instructions) 7 Beneficiary - Enter your share o
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
individual: Enter the amount from Form NYC-202, line 21, or Form NYC-2025. line 8 (see Instr.) Part-year resident Individual: Enter the amount from Worksheet A, line 5 (on page 2) 65233.00 Part 3 - Beneficiary's share of unincorporated business taxes(soe Instructions) 7 Beneficiary - Enter your share of
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
individual: Enter the amount from Form NYC-202. line 21, or Form NYC.202S. Lie 8 (see friStr.) Part-year resident Individual: Enter the amount from Worksheet A, line 5 (on page 2) el 65115.00 Part 3 - Beneficiary's share of unincorporated business taxes (see Instructions) 7 Beneficiary - Enter your share
Entities connected to both BSA Efiling and Worksheet A

U.S. Treasury
ORGANIZATIONFBAR S gnature
ORGANIZATIONthe Foreign Bank and Financial Accounts Report
ORGANIZATIONForeign Bank
ORGANIZATIONPreparer
ORGANIZATIONFiler
PERSONSpouse
ORGANIZATION
FinCEN
ORGANIZATION
NEW YORK NY
LOCATIONthe Dept. of Finance
ORGANIZATIONU.B.T.
ORGANIZATION
New York
LOCATIONNY State
ORGANIZATION
New York State
LOCATION
Empire State
LOCATIONthe U.S. Treasury Financial Agent
ORGANIZATIONConservation Reserve Program
ORGANIZATIONthe New York State Tax Department
ORGANIZATIONWomen's Cancers Education and Prevention Fund
ORGANIZATIONNY City
LOCATION