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ntry AUSTRIA ISignature 144a Check here LXJ if this report is completed b a third party preparer and complete the third party preparer section. 44 Filer signature 1I. repon v. I be elocircniceny *kiwi when filed 45 Filer title. if not reporting a personal account 46 Dattlate wlepa Mn the HMO le a
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
ntry AUSTRIA Signature I 44a Check here LxJ if this report is completed b a third party preparer and complete the third party preparer section. 44 Filer signature Ilso ropon v. ii beeleCtrCnIcelly *IOW when Ned 45 Filer title. if not reporting a personal account 146 Date (MWDD Ma date will auto.I
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
untry AUSTRIA Signature I 44a Check here LXJ if this report is completed b a third party preparer and complete the third arty proposer section. 44 Filer signature naa rap I be eleCtranIcaily signed when sled 45 Filer title. if not reporting a personal account 146 Date (MM/DD Ma date will auloitn
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
Entities connected to both Filer and Bribery Involving Public Servants

United States
LOCATION
FinCEN
ORGANIZATIONMaria Farmer
PERSON
U.S. Treasury
ORGANIZATION
New York City
LOCATIONPreparer
ORGANIZATION
Joi Ito
PERSONSpouse
ORGANIZATION
New York
LOCATION
NEW YORK NY
LOCATIONthe U.S. Treasury Financial Agent
ORGANIZATIONConservation Reserve Program
ORGANIZATIONConservation Reserve
ORGANIZATIONC-EZ
ORGANIZATIONERO Signature
ORGANIZATIONSchedule SE
PERSONFBAR S gnature
ORGANIZATION
Empire State
LOCATIONForeign Bank
ORGANIZATIONBSA Efiling
ORGANIZATION