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1615964 0 1. 2. 3. 4. 5. Part B Declaration of taxpayer and authorizations for Forms IT-201, IT-201-X, IT-203, IT-203-X, IT-214, NYC-208, and NYC-210 Under penalty of perjury, I declare that I have examined the information on my 2017 New York State electronic personal income tax return, including
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
1616657 0 1. 2. 3. 4. 5. Part B Declaration of taxpayer and authorizations for Forms IT-201, IT-201-X, IT-203, IT-203-X, IT-214, NYC-208, and NYC-210 Under penalty of perjury, I declare that I have examined the information on my 2017 New York State electronic personal income tax return, including
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
1540837 0 1. 2. 3. 4. 5. Part B Declaration of taxpayer and authorizations for Forms IT-201, IT-201-X, IT-203, IT-203-X, IT-214, NYC-208, and NYC-210 Under penalty of perjury, I declare that I have examined the information on my 2017 New York State electronic personal income tax return, including
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 NYC-210 and Bribery Involving Public Servants
Yonkers
LOCATION
Empire State
LOCATIONSpouse
ORGANIZATIONFirst Installment
ORGANIZATIONthe New York State Tax Department
ORGANIZATIONWomen's Cancers Education and Prevention Fund
ORGANIZATION
New York
LOCATIONPersonal Income Tax Information Center
ORGANIZATIONNY City
LOCATION
New York State
LOCATIONBreast Cancer Research Fund
ORGANIZATIONTHE NY TAX DEPT
ORGANIZATIONNY State
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
ORGANIZATIONForeign Bank
ORGANIZATION