8
Shared Docs
8
Same-Page
11 / 8
Mentions
73-031 (4/11) Page 1 of 4 EFTA01731219 Part 4:,case irifOr.Matiok, •Note: Please complete all Information below. 1. Is the Victim currently in the United State 2. The Victim's current immigration status: 3. Is the Victim requesting Continued Presence based upon a pending civil action under 18 U.S.C. § 1595
t Name) 3.b. Given Name (First Name) 3.c. Middle Name 4. Class of Admission at Last Entry into the United States E2 5. Place of Last En into the United States City and State) Form 1-102 10/19/17 N Page 2 of 4 EFTA01731225 Part 4. Statement, Certification, Signature, and Contact Information of the Applicant
Street Number and Name 3.b. Apt. K Ste. 3.c. City or Town 3.d. State 3.f. Province 3.g. Postal Code 3.6. Preparer's Contact Information 4. Preparer's Daytime Telephone Number 5. Preparer's Fax Number 6. Preparer's E-mail Address Preparer's Declaration By my signature, I certify, swear, or a
n collected older the GSA may recult in criminal or civil :webs:. 998062400000C VSO EFTA01656583 FinCEN I Financial Crimes Enforcement Network United Sates Dcpartmatt d the ricbuty FBAR Transcript BSA: 30000042934480 and DCN:20101821223560 Filing Information Filing Type(s) Initial Report Filing Date
collected older the BSA may result in criminal or civil sanctions. Z6L550£400000£ ySO EFTA01656577 FinCEN Financial Crimes Enforcement Network United State, Depatunent of the rmousy FBAR Transcript BSA: 30000043055792 and DCN:20101910292960 Information on Financial Account(s) Owned Separately Account
75009 - Enhanced Country FR FR - Enhanced Signature Signature Date 108/18/2017 Third Party Preparer Use Only Preparer's Last Name HASSON CPA Preparer's First Name DAVID Preparer's MI M Preparer's TIN Identification Type PTIN Identification Number Phone Number Preparing Firm's Name SHR, CPA S
73-031 (4/11) Page 1 of 4 EFTA01684004 Part 4:,case irifOr.Matiok, •Note: Please complete all Information below. 1. Is the Victim currently in the United State 2. The Victim's current immigration status: 3. Is the Victim requesting Continued Presence based upon a pending civil action under 18 U.S.C. § 1595
t Name) 3.b. Given Name (First Name) 3.c. Middle Name 4. Class of Admission at Last Entry into the United States E2 5. Place of Last En into the United States City and State) Form 1-102 10/19/17 N Page 2 of 4 EFTA01684010 Part 4. Statement, Certification, Signature, and Contact Information of the Applicant
Street Number and Name 3.b. Apt. K Ste. 3.c. City or Town 3.d. State 3.f. Province 3.g. Postal Code 3.6. Preparer's Contact Information 4. Preparer's Daytime Telephone Number 5. Preparer's Fax Number 6. Preparer's E-mail Address Preparer's Declaration By my signature, I certify, swear, or a
ithdraw the amount from that account As New York does not support International ACH Transactions (IAT), I attest the source for these funds is within the United States. I understand and agree that I may revoke this authorization for payment only by contacting the Tax Department no later than five (5) business days p
en filed 45 Filer title. if not reporting a personal account 46 Dattlate wlepa Mn the HMO le aottonelIteignel Third Party Preparer Use Only 47 Preparer's last name WEISS 48 First name DAVID 49 MI 50 Check LJ if selfomployedp0096 51 TIN 2062 51a TIN type I XI PTIN 0 SSNATIN Foreign 52 Cont
ithdraw the amount from that account As New York does not support International ACM Transactions (IAT), I attest the source for these funds is within the United States. I understand and agree that I may revoke this authorization for payment only by contacting the Tax Department no later than five (5) business days p
if not reporting a personal account 146 Date (MWDD Ma date will auto.I N Men the FBAR is ay.t.tionaiit ore, Third Party Preparer Use Only 47 Preparer's last name WEISS 48 First name DAVID 49 M 50 Check if self -employed x 51a TIN type I I PTIN SSNATIN Foreign 52 Contact phone no. sza Ex
ithdraw the amount from that account As New York does not support International ACH Transactions (IAT), I attest the source for these funds is within the United States. I understand and agree that I may revoke this authorization for payment only by contacting the Tax Department no later than five (5) business days p
r title. if not reporting a personal account 146 Date (MM/DD Ma date will auloitnneMn the nswisaanuol el gnea Third Party Preparer Use Only 47 Preparer's last name WEISS 48 First name DAVID 49 MI 50 Checks I if so-mow/3O)00962062 51 TIN 51a TIN type I XI PTIN SSNATIN Foreign 52 Contact pho
CK. B. COHEN & J. HANNAN TRUSTEES FB0 JOSHUA BLACK(11/30/92) Home address (number end street or rural route) C/o J. HANNAN, TTEE, 1301 AVE., OF THE AMERICAS City, village, or post office State NEW YORK NY 10019 Business name and address, if different from above Federal identification number (deny) 1
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
ENFORCEMENT SENSITIVE ICE Form 73-031 (4/11) Page 1 of 4 EFTA01699758 *Note: Please complete all information below. 1. Is the Victim currently in.the United States? El Yes O No 2. The Victim's current immigration status: In the U.S. on an E-2 Visa 3. is the Victim requesting Continued Presence based upon a pen
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
Entities connected to both United States and Preparer

Jeffrey Epstein
PERSON
George W. Bush
PERSONLeon Black
PERSONFBI
ORGANIZATION
New York
LOCATIONMaria Farmer
PERSON
New York City
LOCATION
NEW YORK NY
LOCATION
Woody Allen
PERSON
Joi Ito
PERSON
U.S. Treasury
ORGANIZATION
New York State
LOCATION
Mao Zedong
PERSONNadia Marcinkova
PERSON
Maine
LOCATION
the Internal Revenue Service
ORGANIZATION
Homeland Security
ORGANIZATION
Department of Homeland Security
ORGANIZATIONAlbany
LOCATION
Slovakia
LOCATION