3
Shared Docs
3
Same-Page
3 / 3
Mentions
instructions) b Adjustment for net income or loss derived in the ordinary course of a non•section 1411 trade or business (see instructions) c Combine Ines 4a and 4b 6a Net gain or loss from disposition of property (see instructions) b Net gain or loss from disposition of property that is not subject
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
40, line 17; or Form 1041, line 5) b Adjustment for net income or loss derived in the ordinary course of a ncri.section 1411 trade or business e Combine Ines 4a and 4b 5a Net gain or loss from disposition of property from Fenn 1040. combine lines 13 and 14; or from Form 1041. combine lines 4 and 7 b Net
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
instructions) b Adjustment for net income or loss derived in the ordinary course of a non•section 1411 trade or business (see instructions) c Combine Ines 4a and 4b 6a Net gain or loss from disposition of property (see instructions) b Net gain or loss from disposition of property that is not subject
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 Combine Ines 4a and Bribery Involving Public Servants
Utilities
ORGANIZATIONQualifying widow(er
ORGANIZATIONConservation Reserve Program
ORGANIZATIONSchedule SE
PERSONthe Foreign Earned Income Tax Worksheet
ORGANIZATIONConservation Reserve
ORGANIZATIONVeterans'
ORGANIZATIONDefrauding the Government
ORGANIZATIONTotal New York State
ORGANIZATIONWorksheet A
ORGANIZATIONForm IT-20VATT
ORGANIZATIONFirst Installment
ORGANIZATIONSecond Installment
ORGANIZATIONU.B.T.
ORGANIZATION
Empire State
LOCATIONthe U.S. Treasury Financial Agent
ORGANIZATIONthe Dept. of Finance
ORGANIZATIONTaxpayer for Forms NYC-202, NYC-202S
ORGANIZATIONSpouse
ORGANIZATIONJohn O. Smith
PERSON