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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
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
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
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
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
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 C-EZ and Worksheet A

U.S. Treasury
ORGANIZATIONthe Foreign Earned Income Tax Worksheet
ORGANIZATIONSchedule SE
PERSONthe U.S. Treasury Financial Agent
ORGANIZATION
United States
LOCATIONERO Signature
ORGANIZATIONSpouse
ORGANIZATION
FinCEN
ORGANIZATIONConservation Reserve
ORGANIZATIONJurat/Disclosure
ORGANIZATIONConservation Reserve Program
ORGANIZATIONUtilities
ORGANIZATIONFiler
PERSON
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