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enalty (unless box B.C. or D applies). LHA For Paperwork Reduction Act Notice, see separate Instructions. Form 2210 (2014) 412501 12-23-14 8.1 SIROOCHENKO 2014.03000 SIROOCHENKO, ANASTASIYA SIROOCH1 EFTA00791944 Form2210(2M4) ANASTASIYA SIROOCHENKO Regular Method (See the instructions if you aro f

he following amount for your filing status: Married filing jointly $250,000 Married filing separately $125,000 Single, Head of household, or Qualifying widow(er) $200,000 6 Subtract line 5 from line 4. If zero or less. enter O- 6 7 Additional Medicare Tax on Medicare wages. Multiply line 6 by 0.9% (.009).

YYY In SSNATIN a Type' Passport IMI Foreign TIN Other ON b Number c Country of Issue number complete item 4 6 Last name or organization name SIROOCHENKO 7First name ANASTAS I YA 8 Middle initial 8a Suffix 9 Mailing address (number, street. and apt. or suite no.) 10 City NEW YORK 11 State NY 1

he following amount for your filing status: Married filing jointly $250,000 Married filing separately $125,000 Single, Head of household, or Qualifying widow(er) $200,000 9 200,000. 10 Enter the amount from line 4 10 11 Subtract line 10 from line 9. If zero or less. enter .0- 11 200,000. 12 Subtract

7 Passport c Other In SSNATIN a Type: CI Foreign TIN EIN b Number Country of Issue number complete item 4 6 Last name or organization name SIROOCHENKO 7First name ANASTAS I YA 8 Middle initial 8a Suffix 9 Mailing address (number, street. and apt. or suite no.) 288 WEST 4TH ST 10 City NEW YORK

he following amount for your filing status: Married filing jointly $250,000 Married filing separately $125,000 Single. Head of household, or Qualifying widow(er) $200,000 9 200,000. 10 Enter the amount from line 4 10 11 Subtract line 10 from line 9. If zero or less. enter .0- 11 200,000. 12 Subtract