3
Shared Docs
3
Same-Page
3 / 3
Mentions
arm partnerships. Schedule K1 (Form 1065), box 14, code A b If you received social security retirement or disability benefits, enter the amount of Conservation Reserve Program payments included on Schedule F. line 4b. or listed on Schedule K1 (Form 1065), box 20, code Z 2 Net profit or (loss) from Schedule C. lin
1 s 1T-201LATT Name(s) as shown on your Form IT•201 ANASTASIYA SIROOCHENKO A Have you (or an entity of which you are an owner) been convicted of Bribery Involving Public Servants and Related Offenses, Corrupting the Government, or Defrauding the Government (NYS Penal Law Article 200. 496. or section 195.20)? (see instruction
arm partnerships, Schedule K1 (Form 1065), box 14, code A b If you received social security retirement or disability benefits, enter the amount of Conservation Reserve Program payments included on Schedule F. line 4b. or listed on Schedule K1 (Form 1065), box 20, code Z 2 Net profit or (loss) from Schedule C, lin
shown on your FormIT.201 ANASTASIYA SIROOCHENKO Your social security number. A Have you (or an entity of which you are an owner) been convicted of Bribery Involving Public Servants and Related Offenses, Corrupting the Government, or Defrauding the Government (NYS Penal Law Article 200. 496. or section 195.20)? (see instruction
d farm partnerships, Schedule (Form 1065), box 14, code A b If you received social security retirement or disability benefits, enter the amount of Conservation Reserve Program payments included on Schedule F. line 4b. or listed on Schedule K-1 (Form 1065), box 20. code Z 2 Net profit or (loss) from Schedule C. l
your Form IT•201 Your social security number ANASTASIYA SIROOCHENKO 9816 A Have you (or an entity of which you are an owner) been convicted of Bribery Involving Public Servants and Related Offenses, Corrupting the Government, or Defrauding the Government (NYS Penal Law Article 200, 496. or section 195.20)? (see instruction
Entities connected to both Conservation Reserve and Bribery Involving Public Servants
the Foreign Earned Income Tax Worksheet
ORGANIZATIONSchedule SE
PERSONConservation Reserve Program
ORGANIZATIONFiler
PERSON
FinCEN
ORGANIZATIONQualifying widow(er
ORGANIZATIONCombine Ines 4a
ORGANIZATION
U.S. Treasury
ORGANIZATIONUtilities
ORGANIZATIONJurat/Disclosure
ORGANIZATIONERO Signature
ORGANIZATIONC-EZ
ORGANIZATIONthe U.S. Treasury Financial Agent
ORGANIZATION
United States
LOCATIONSpouse
ORGANIZATIONthe 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