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$ 0 SEPTEMBER 17, 2018 No. 4 $ 0 JANUARY 15, 2019 Make check payable to UNITED STATES TREASURY Mail voucher and check (if applicable) to INTERNAL REVENUE SERVICE CENTER P.O. BOX 37007 HARTFORD, CT 06176-7007 Special Instructions INCLUDE YOUR SOCIAL SECURITY NUMBER AND THE 1040-ES" ON YOUR CHECK. VOUCHERS NEED
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
SEPTEMBER 17, 2018 No. 4 $ 443,400 JANUARY 15, 2019 Make check payable to UNITED STATES TREASURY Mail voucher and check (if applicable) to INTERNAL REVENUE SERVICE CENTER P.O. BOX 37007 HARTFORD, CT 06176-7007 Special Instructions INCLUDE YOUR SOCIAL SECURITY NUMBER AND THE 1040-ES" ON YOUR CHECK. VOUCHERS NEED
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
S TREASURY. INCLUDE YOUR SOCIAL SECURITY NUMBER, DAYTIME PHONE NUMBER, AND THE WORDS "2017 FORM 4868" ON YOUR CHECK. MAIL AS SOON AS POSSIBLE TO: INTERNAL REVENUE SERVICE CENTER III. BOX 37009 HARTFORD, CT 06176-7009 718711 06.15.17 • DETACH HERE • 4868 Department Otte, Traaluy Intornal Inryinnun Snrvictr Fix Cale A
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 INTERNAL REVENUE SERVICE CENTER and Bribery Involving Public Servants

New York State
LOCATIONMaria Farmer
PERSONYonkers
LOCATIONSchedule SE
PERSONNY State
ORGANIZATION
Empire State
LOCATIONVeterans'
ORGANIZATIONDefrauding the Government
ORGANIZATIONTotal New York State
ORGANIZATIONWorksheet A
ORGANIZATIONForm IT-20VATT
ORGANIZATIONFirst Installment
ORGANIZATIONSecond Installment
ORGANIZATIONU.B.T.
ORGANIZATIONthe U.S. Treasury Financial Agent
ORGANIZATIONConservation Reserve Program
ORGANIZATIONthe Dept. of Finance
ORGANIZATIONSpouse
ORGANIZATIONTaxpayer for Forms NYC-202, NYC-202S
ORGANIZATIONthe New York State Tax Department
ORGANIZATION