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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
ty claim of right credit 17 Yonkers claim of right credit 17a MCTMT (metropolitan commuter transportation mobility tax) claim of right credit 18 Total New York State, New York City, Yonkers, and MCTMT other refundable credits (add lines 14 through 17a; enter here and on Form IT-201, One 71) Part 2 - Other New
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
ty claim of right credit 17 Yonkers claim of right credit 17a MCTMT (metropolitan commuter transportation mobility tax) claim of right credit 18 Total New York State, New York City, Yonkers, and MCTMT other refundable credits (add lines 14 through 17a; enter here and onForm 1T-201, One 71) Part 2 - Other New Y
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
ty claim of right credit 17 Yonkers claim of right credit 17a MCTMT (metropolitan commuter transportation mobility tax) claim of right credit 18 Total New York State, New York City, Yonkers, and MCTMT other refundable credits (add lines 14 through 17a; enter here and onForm IT-201, One 71) Part 2 - Other New Y
Entities connected to both Bribery Involving Public Servants and Total New York State
THE NY TAX DEPT
ORGANIZATIONNYC-210
ORGANIZATIONOointly
ORGANIZATION
Empire State
LOCATIONNYS/NYC
ORGANIZATIONthe U.S. Treasury Financial Agent
ORGANIZATIONKICTIM
ORGANIZATIONBreast Cancer Research Fund
ORGANIZATION60e Olympic Fund
ORGANIZATIONConservation Reserve Program
ORGANIZATIONVeterans'
ORGANIZATIONDefrauding the Government
ORGANIZATIONWorksheet A
ORGANIZATIONForm IT-20VATT
ORGANIZATIONFirst Installment
ORGANIZATIONSecond Installment
ORGANIZATIONU.B.T.
ORGANIZATIONSpouse
ORGANIZATIONthe New York State Tax Department
ORGANIZATIONthe Dept. of Finance
ORGANIZATION