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END THIS RECORD TO FinCEN UNLESS REQUESTED TO DO SO. 720011 04.01.17 Rev. 10.7 May 21, 2015 EFTA00792092 ENCLOSE A CHECK FOR $500000, PAYABLE TO THE UNITED STATES 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 R
9 blank 4 , Voluntary contributions] (see page 27) 60a Return a Gift to Wildlife 60a .00 60b Missing/Exploited Children Fund 60b .00 60c Breast Cancer Research Fund 60c .00 60d Alzheimer's Fund 60d .00 60e Olympic Fund ($2 or $4; see page 27) 60e .00 601 Prostate and Testicular Cancer Research and Ed
END THIS RECORD TO FInCEN UNLESS REQUESTED TO DO SO. 720011 04-01.17 Rev. 10.7 May 21, 2015 EFTA00792182 ENCLOSE A CHECK FOR $500000, PAYABLE TO THE UNITED STATES 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 R
9 blank ) 04'pr Voluntary contributions (see page 27) 60a Return a Gift to Wildlife 60a .00 60b Missing/Exploited Children Fund 60b .00 60c Breast Cancer Research Fund 60c .00 60d Alzheimer's Fund 60d .00 60e Olympic Fund ($2 a $4; see page 27) 60e .00 601 Prostate and Testicular Cancer Research and Edu
SEND THIS RECORD TO FinCEN UNLESS REQUESTED TO DO SO. 720011 0441.17 Rev. 10.7 May 21.2015 EFTA00792004 ENCLOSE A CHECK FOR $500000, PAYABLE TO THE UNITED STATES 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 R
9 blank ) 04'pr Voluntary contributions (see page 27) 60a Return a Gift to Wildlife 60a .00 60b Missing/Exploited Children Fund 60b .00 60c Breast Cancer Research Fund 60c .00 60d Alzheimer's Fund 60d .00 60e Olympic Fund (52 a $4; see page 27) 60e .00 601 Prostate and Testicular Cancer Research and Edu
Entities connected to both THE UNITED STATES TREASURY and Breast Cancer Research Fund
NY City
LOCATION
New York
LOCATIONPersonal Income Tax Information Center
ORGANIZATION
Empire State
LOCATION
New York State
LOCATIONNY State
ORGANIZATIONNYC-210
ORGANIZATIONSpouse
ORGANIZATIONFirst Installment
ORGANIZATIONYonkers
LOCATIONthe New York State Tax Department
ORGANIZATIONWomen's Cancers Education and Prevention Fund
ORGANIZATIONTHE NY TAX DEPT
ORGANIZATIONConservation Reserve Program
ORGANIZATIONTaxpayer for Forms NYC-202, NYC-202S
ORGANIZATIONJohn O. Smith
PERSONthe New York State Department of Taxation and Finance
ORGANIZATIONWEISS
ORGANIZATIONFBAR S gnature
ORGANIZATIONthe Foreign Bank and Financial Accounts Report
ORGANIZATION