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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
5 • June 15 = (61 365) x 7.5% = .01253 - Or - April 15 l* 365)x 7.5%= • 32 Multiply line 30. column A by line 31 30 31 32 2965.00 37 oc. Second Installment (June 15 - September 15, 20 7) 33 June 15 • September 15 = (92 365) x 7.5% = .01890 June 15. =( 365) x 7.5% = 34 Multiply line 30. column 8 by l
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
5 • June 15 = (61 365) x 7.5% = .01253 - Or - April 15 l* 365)x 7.5%= • 32 Multiply line 30. column A by line 31 30 31 32 2965.00 37 oc. Second Installment (June 15 - September 15, 20 7) 33 June 15 • September 15 = (92 365) x 7.5% = .01890 June 15. =( 365) x 7.5% = 34 Multiply line 30. column 8 by l
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
5 • June 15 = (61 365) x 7.5% = .01253 - or - April 15 • It365)x 7.5%. • 32 Multiply line 30. column A by line 31 30 31 32 1111 co 14 cc Second Installment (June 16 - September 15, 20 7) 33 June 15 September 15 = (92 + 365) x 7.5% = .01890 June 15. =( + 365) x 7.5% = • 34 Multiply line 30, column B
Entities connected to both BSA Efiling and Second Installment

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