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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
Stop: enter line 11 amount on Form IT205, line 22 New York City full-year resident Individuals 12 Amount from Form IT•201. fine 49 13 Amount from Form IT-20VATT, line 32 14 Amount from Form IT-20VATT, line 33 15 Add lines 12. 13, and 14 16 Enter the lesser of line 11 or 15, and transfer the amount to Form
2 mentions1 same-page
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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
top: enter line 11 amount on Form IT-205, line 22 New York City full-year resident individuals 12 Amount from Form fT•201. line 49 13 Amount from Form IT-20VATT, line 32 14 Amount from Form IT-20VATT, line 33 15 Add lines 12. 13. and 14 16 Enter the lesser of line 11 or 15, and transfer the amount to Form
2 mentions1 same-page
Page ?Same page
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
line 22 New York City full-year resident Individuals 12 Amount from Form IT•201. line 49 13 Amount from Form IT-201401T, line 32 14 Amount from Form IT-20VATT, line 33 15 Add Ines 12. 13. and 14 16 Enter the lesser of line 11 or 15, and transfer the amount to Form If-201•ATT, line 8 219001171019 III I
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Entities connected to both THE UNITED STATES TREASURY and Form IT-20VATT
NYC-210
ORGANIZATION3 w/ THE·3 w/ Form
New York State
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NYS/NYC
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Empire State
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KICTIM
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Breast Cancer Research Fund
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60e Olympic Fund
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the U.S. Treasury Financial Agent
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Veterans'
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Bribery Involving Public Servants
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Defrauding the Government
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Total New York State
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Worksheet A
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First Installment
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Second Installment
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U.B.T.
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Conservation Reserve Program
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Spouse
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the Dept. of Finance
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the New York State Tax Department
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