3
Shared Docs
3
Same-Page
3 / 3
Mentions
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
unknown 16 Type of account aLLI Bank bLJ Securities cl I Other Enter type below Lai 17 Name of financial institution in which account is held UNICREDIT BANK AUSTRIA AG 18 Account number i nation ******** 19 Mailing address (number, street, apt. or suite no.) of financial institution in which account is held SCH
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
own 16 Type of account aLLI Bank bU Securities cl I Other Enter type below 11,781. Li 17 Name of financial institution In which account is held UNICREDIT BANK AUSTRIA AG 18 Account number or other designation *********6463 19 Mailing address (number, street, apt. or suite no.) of financial institution in which acco
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
nown 16 Type of account aLXJ Bank bU Securities cl I Other Enter type below 11,781. Li 17 Name of financial institution In which account is held UNICREDIT BANK AUSTRIA AG 18 Account number or other designation *********6463 19 Mailing address (number, street, apt. or suite no.) of financial institution in which acco
Entities connected to both C-EZ and UNICREDIT BANK AUSTRIA AG
Schedule SE
PERSONthe U.S. Treasury Financial Agent
ORGANIZATION
U.S. Treasury
ORGANIZATIONERO Signature
ORGANIZATION
United States
LOCATIONSpouse
ORGANIZATIONthe Foreign Earned Income Tax Worksheet
ORGANIZATIONFiler
PERSON
FinCEN
ORGANIZATIONConservation Reserve
ORGANIZATIONConservation Reserve Program
ORGANIZATIONUtilities
ORGANIZATIONJurat/Disclosure
ORGANIZATION
New York State
LOCATION
Empire State
LOCATIONthe Dept. of Finance
ORGANIZATIONTaxpayer for Forms NYC-202, NYC-202S
ORGANIZATIONJohn O. Smith
PERSONthe New York State Tax Department
ORGANIZATIONWomen's Cancers Education and Prevention Fund
ORGANIZATION