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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
ake sure that your name is spelled correctly. You should enter your first name, middle initial, then last name in the spaces provided (for example, John O. Smith). Your name must agree with the name on your New York State income tax return. • Foreign addresses - Enter the information in the following order:
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
ake sure that your name is spelled correctly. You should enter your first name, middle initial, then last name in the spaces provided (for example, John O. Smith). Your name must agree with the name on your New York State income tax return. • Foreign addresses - Enter the information in the following order:
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
ake sure that your name is spelled correctly. You should enter your first name, middle initial, then last name in the spaces provided (for example, John O. Smith). Your name must agree with the name on your New York State income tax return. • Foreign addresses - Enter the information in the following order:
Entities connected to both Bribery Involving Public Servants and John O. Smith
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