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ect all applicable boxes) K White K Asian K Black or African K American Indian American or Ala
n, Declaration, and Signature of the Person Preparing This Application, if Other Than the Applicant (continued) Preparer's Contact Information 4. Preparer's Daytime Telephone Number 6. Preparer's Email Address (if any) A- 5. Preparer's Mobile Telephone Number (if any) Preparer's Statement 7. A. K
CTIONS PERSONAL IDENTIFICATION L INFORM/G:0N IN BLACK LAS NAM FIRST NAME MIDDLE MME FIN LEAVE BLA
IP Code N I D2 78 3.f. Province 3.g. Postal Code 3.h. Country 2a FED6_12AL PLA2A FIr. 0 Li N ran smerec Pireparer's Contact Information 4. Preparer's Daytime Telephone Number 5. Preparer's Fax Number 6. Preparer's E-mail Address 7.a. g I am not an attorney or accredited representative but h
T.V.A. N° d'identification FR : 03 402 315 063 BLACK GRANTOR TRUSTS OR D FBO/ Benjamin /// 3492 FBO
return and payment to: NYS TAX DEPARTMENT SALES TAX DESK AUDIT ASUAL SALES UNIT dUILDING 9 3RD FLOOR W A HARRIMAN CAMPUS ALBANY NY 12227-0125 Preparer's social security number 153-38-2770 Date Employer identification number 13-3959372 STF NY40568F EFTA_R1_01947145 EFTA02672895 THOMAS TURRIN
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