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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
certify that this return, Including any accompanying rider, is, to the best of my knowledge and belief, true, correct fin' and complete. I authorize the Dept. of Finance to discuss this return with the preparer listed below. (See Instr.) YES X man AllariltS9 SIGN HERE: Seamier° of laxpirear Tali) Data Presort(
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
reby certify that this return, including any accompanying rider, is, to the best of my knowledge and belief, true, correct and complete. I authorize the Dept. of Finance to discuss this return with the preparer listed below. (See Instr.) YES X Fin's Email Merin: SIGN HERE: Signature of taxPirra' Date Wenn(' sae
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
at this return, including any accompanying rider, is, to the best of my knowledge and belief, true, correct Firwsernmmosst and complete. I authorize the Dept. of Finance to discuss this return with the preparer listed below. (See Instr.) YES X INFO@DAVI DWE I S SCP SIGN HERE: Secretor° of !tapir/or Trio Data P
Entities connected to both Bribery Involving Public Servants and the Dept. of Finance
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
ORGANIZATIONTotal New York State
ORGANIZATIONWorksheet A
ORGANIZATIONForm IT-20VATT
ORGANIZATIONFirst Installment
ORGANIZATIONSecond Installment
ORGANIZATIONU.B.T.
ORGANIZATIONSpouse
ORGANIZATIONthe New York State Tax Department
ORGANIZATION