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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
0k .00 601 Mental Illness AntiStigrna Fund 601 .00 60m Women's Cancers Education and Prevention Fund 60m .00 60n Autism Fund 60n .00 60o Veterans' Homes 60o .00 60 Total voluntary contributions (add tines 60a through 60o) 61 Total New York State, New York City, Yonkers, and sales or use ta
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
0k .00 601 Mental Illness Anti-Stigma Fund 601 .00 60m Women's Cancers Education and Prevention Fund 60m .00 60n Autism Fund 60n .00 60o Veterans' Homes 60o .00 60 Total voluntary contributions (add tines 60a through 60o) 61 Total New York State, New York City, Yonkers, and sales or use ta
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
0k .00 60I Mental Illness Anti-Stigma Fund 601 .00 60m Women's Cancers Education and Prevention Fund 60m .00 60n Autism Fund 60n .00 60o Veterans' Homes 60o 00 60 Total voluntary contributions (add fines 60a through 60o) 61 Total Now York State, New York City, Yonkers, and sales or use tax
Entities connected to both THE UNITED STATES TREASURY and Veterans'
NYC-210
ORGANIZATION
New York State
LOCATIONNYS/NYC
ORGANIZATION
Empire State
LOCATIONKICTIM
ORGANIZATIONBreast Cancer Research Fund
ORGANIZATION60e Olympic Fund
ORGANIZATIONthe U.S. Treasury Financial Agent
ORGANIZATIONBribery Involving Public Servants
ORGANIZATIONDefrauding the Government
ORGANIZATIONTotal New York State
ORGANIZATIONWorksheet A
ORGANIZATIONForm IT-20VATT
ORGANIZATIONFirst Installment
ORGANIZATIONSecond Installment
ORGANIZATIONU.B.T.
ORGANIZATIONConservation Reserve Program
ORGANIZATIONSpouse
ORGANIZATIONthe Dept. of Finance
ORGANIZATIONthe New York State Tax Department
ORGANIZATION