Caution: Forms printed from within Adobe Acrobat products may not meet IRS or state taxing agency specifications. When using Acrobat 9.x products and later products, select "None"in the "Page Scaling" selection box in the Adobe "Print" dialog. CLIENT'S COPY EFTA00791995
DirextDepoWVNIARepon Name: ANASTASIYA SIROOCHENKO Unit FO'111 Name of Financial Institution Account Type Routing Number Account Number Debit/Deposit Date Amount FED 1040 CHECKING S . 021000021 *****0359 t DEBIT 10/10/18 9,916. IIIIII: ID Number. * * * - ** 703481 05-23-17 EFTA00791996
DAVID WEISS CPA, PLLC 183 MADISON AVE SUITE 803 NEW YORK, NY 10016-4403 (212) 695-5771 OCTOBER 10, 2018 ANASTASIYA SIROOCHENKO DEAR ANASTASIYA: ENCLOSED ARE YOUR 2017 INCOME TAX RETURN AND 2018 ESTIMATED TAX VOUCHERS. SPECIFIC FILING INSTRUCTIONS ARE AS FOLLOWS. FEDERAL INCOME TAX RETURN: THIS RETURN HAS QUALIFIED FOR ELECTRONIC FILING AND THE PRACTITIONER PIN PROGRAM HAS BEEN ELECTED. AFTER REVIEWING THE RETURN FOR COMPLETENESS AND ACCURACY, PLEASE SIGN AND RETURN FORM 8879 TO OUR OFFICE BY MAIL, E-MAIL ([email protected]), OR FAX (212-695-5772). WE WILL THEN TRANSMIT YOUR RETURN ELECTRONICALLY TO THE IRS, AND NO FURTHER ACTION IS REQUIRED. RETURN FEDERAL FORM 8879 TO US AS SOON AS POSSIBLE (BY OCTOBER 15, 2018). YOUR BALANCE DUE OF $9,916 WILL BE AUTOMATICALLY WITHDRAWN FROM YOUR ACCOUNT ENDING IN 0359 ON OR AFTER OCTOBER 10, 2018. REFER TO FORM 1040 ON THE DIRECT DEPOSIT/DEBIT REPORT FOR COMPLETE ACCOUNT INFORMATION. FEDERAL ESTIMATED TAX VOUCHERS: SEPARATELY MAIL VOUCHER 2 OF FORM 1040-ES AS SOON AS POSSIBLE. MAIL TO - INTERNAL REVENUE SERVICE CENTER III. BOX 37007 HARTFORD, CT 06176-7007 ENCLOSE YOUR CHECK FOR $200,000, PAYABLE TO THE UNITED STATES TREASURY. INCLUDE YOUR SOCIAL SECURITY NUMBER AND THE WORDS "2018 FORM 1040-ES" ON YOUR CHECK. FOR YOUR REFERENCE WE HAVE LISTED ALL ESTIMATED TAX PAYMENTS AND THEIR ORIGINAL DUE DATES BELOW. VOUCHERS REQUIRING NO PAYMENT SHOULD NOT BE FILED. EFTA00791997
VOUCHER NO. 1 BY 04/17/18 NO PAYMENT REQUIRED VOUCHER NO. 2 BY 06/15/18 $200,000 VOUCHER NO. 3 BY 09/17/18 NO PAYMENT REQUIRED VOUCHER NO. 4 BY 01/15/19 $400,000 YOUR COPY OF THE SUGGEST THAT YOU VERY TRULY YOURS, DAVID WEISS RETURN IS ENCLOSED FOR YOUR FILES. WE RETAIN THIS COPY INDEFINITELY. EFTA00791998
DAVID WEISS CPA, PLLC 183 MADISON AVE SUITE 803 NEW YORK, NY 10016-4403 (212) 695-5771 OCTOBER 10, 2018 ANASTASIYA SIROOCHENKO 288 WEST 4TH ST NEW YORK, NY 10014 DEAR ANASTASIYA: ENCLOSED IS YOUR 2017 FORM 114, REPORT OF FOREIGN BANK AND FINANCIAL ACCOUNTS. YOUR FORM 114 HAS BEEN PREPARED FOR ELECTRONIC FILING. PLEASE SIGN, DATE, AND RETURN FORM 114A TO OUR OFFICE. WE WILL THEN TRANSMIT YOUR FORM TO THE FINCEN. RETURN FORM 114A TO US ON OR BEFORE OCTOBER 15, 2018. YOUR COPY OF THE FORM IS ENCLOSED FOR YOUR FILES. WE SUGGEST THAT YOU RETAIN THIS COPY INDEFINITELY. VERY TRULY YOURS, DAVID WEISS EFTA00791999
FINANCIAL CRIMES ENFORCEMENT NETWORK BSA E-Filing - Report of Foreign Bank and Financial Accounts (FBAR) ANASTAS20170001 Filing Name ANASTASIYA SIROOCHENKO Submission Type NEW PIN NOT REQUIRED FinCEN Form 114 Check here if this report is submitted by an authorized third party, and complete the 3rd party preparer section on page one of the report. The E-tile system will auto complete item 46. NOTE: The FBAR must be received by the Department of the Treasury on or before April 17. 2018. An automatic extension to October 15.2018 is available. This report filed late for the following reason (Check only one): a 0 Forgot to file b c d C O O Did not know that I had to file Thought account balance was below reporting threshold Did not know that my account qualified as toregn e ILI Account statement not received in time z ILI Account statement lost (Replacement requested) Late receiving missing required account information Unable to obtain joint spouse signature in time Unable to access BSA Efiling system Other (please provide explanation below) 773151 05-21-17 EFTA00792000
FinCEN Form 114 REPORT OF FOREIGN BANK AND FINANCIAL ACCOUNTS Do NOT file with your Federal Tax Return 1 This report is for calendar year ended 12/31 2017 Ame n I Part I 1 Filer information 2 Type of filer ANASTAS20170001 a W Individual b Partnership c Corporation d I=1 Consolidated e Fiduciary or other • Enter type 3 U.S. Taxpayer Identification Num *** -** -9816 If filer has no US Identification 3a TIN type 4 Foreign identification (Complete only if item 3 is not applicable) 5 Individual's date of birth MWDDNYYY 07/30/1987 Passport c Other In SSNATIN a Type: CI Foreign TIN EIN b Number Country of Issue number complete item 4 6 Last name or organization name SIROOCHENKO 7First name ANASTAS I YA 8 Middle initial 8a Suffix 9 Mailing address (number, street. and apt. or suite no.) 288 WEST 4TH ST 10 City NEW YORK 11 State NY 12 ZIP/Postal Code 10014 13 Country USA 14 a) Does the filer have a financial interest in 25 or more financial accounts? Yes ILI Enter number of accounts Do not complete Part II or Part III, but maintain records of the Information. No ILM b) Does the filer have signature authority over but no financial Interest in 25 or more financial accounts? Yes I= Enter number of accounts Comp. Part IV, items 34 through 43 for each person on whose behalf the filer has sign. authority. No I Part III information on financial account(s) owned separately 15 Maximum value of account during calendar year 15a Amount unknown 16 Type of account aLXJ Bank bU Securities cl I Other Enter type below 11,781. Li 17 Name of financial institution In which account is held UNICREDIT BANK AUSTRIA AG 18 Account number or other designation *********6463 19 Mailing address (number, street, apt. or suite no.) of financial institution in which account is held SCHOTTENGASSE 6-8 20 City VIENNA 21 State, if known 22 Foreign postal code, if known 1010 WIEN 23 Country 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 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 phone no. 212-695-5771 sza ext. 53 Firm's name DAVID WEISS CPA, PLLC 54 Firm's TIN **-***2756 54a TIN type LXJ EIN Foreign 55 Mailing address (number. stree . apt. or suite no.) 183 MADISON AVE SUITE 803 56 City NEW YORK 57 State NY 58 ZIP/Postal Code 10016-4403 59 Country US 723141 04.01.17 EFTA00792001
OMB No. 1545 0074 as my signature on my tax year 2017 electronically filed income tax return. Form 8879 Department of the Treasury Internal Revenue Service IRS e-file Signature Authorization ► Return completed Form 8879 to your ERO. (Do not send to IRS.) ► Go to www.Irs.gov/Form8879 for the latest Information. 2017 Submission Identification Number (SID) Taxpayer's name ANASTASIYA SIROOCHENKO Spouses name Social security number ***4 "4-9816 Spouse's social security number IPartI Tax Return Information - Tax Year Ending December 31,2017 (whole dollars only) 1 Adjusted gross income (Form 1040, line 38: Form 1040A, line 22; Form 1040EZ, brie 4; Form 1040NR, line 37) 1 1,540,837. 2 Total tax (Form 1040. line 63; Form 1040A, line 39; Form 1040EZ, line 12; Form 1040NR, line 61) 2 556,671. 3 Federal income tax withheld from Forms W2 and 1099 (Form 1040, line 64; Ft:10111040A, line 40; Form 1040EZ, line 7; Form 104014R, line 62a) 4 Refund (Form 1040, line 76a; Form 1040A, line 48a; Form 1040EZ, line 13a; Form 1040SS, Part I, line 13a; Form 1040NR. line 73a) 5 Amount you owe (Form 1040. line 78: Form 1040A. tine 50: Form 1040EZ. line 14: Form 1040NR, line 75) 5 9 671. I Part II l Taxpayer Declaration and Signature Authorization (Be sure you get and keep a copy of your return) Under penalties of perjury, I declare that I have examined a copy of my electronic individual income tax return and accompanying schedules and statements for the tax year ending December 31, 2017, and to the best of my knowledge and belief, it is true, correct and accurately lists all amounts and sources of income I received during the tax year. I further declare that the amounts in Part I above are the amounts from my electronic income tax return. I consent to allow my intermediate service provider, transmitter, or electronic return originator (ERO) to send my return to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of the transmission, (b) the reason for any delay in processing the return or refund, and (c) the date of any refund. It applicable, I authorize the U.S. Treasury and its designated Financial Agent to initiate an ACH electronic funds withdrawal (direct debit) entry to the financial institution account indicated in the tax preparation software for payment of my federal taxes owed on this return and/or a payment of estimated tax, and the financial institution to debit the entry to this account. This authorization is to remain in full force and effect until I notify the U.S. Treasury Financial Agent to terminate the authorization. To revoke (cancel) a payment I must contact the U.S. Treasury Financial Agent at 1-888-353-4537. Payment cancellation requests must be received no later than 2 business days prior to the payment (settlement) date. I also authorize the financial institutions involved n the processing of the electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment. I further acknowledge that the personal identification number (PIN) below is my signature for my electronic income tax return and, if applicable, my Electronic Funds Withdrawal Consent Taxpayer's PIN: cheek one box only * INCLUDES LATE PENALTIES AND INTEREST: M I authorize DAVID WEISS CPA, PLLC to enter or generate my PIN ERO firm name Enter five digits, but as my signature on my tax year 2017 electronically filed income tax return. don't enter all zeros I will enter my PIN as my signature on my tax year 2017 electronically filed income tax return. Check this box only if you are entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below. 9,916. 6 4 9 8 1 Your signature ► Date ► 10/10/2018 Spouse's PIN: cheek one box only I authorize to enter or generate my PIN ERO firm name Enter five digits, but don't enter all zeros I will enter my PIN as my signature on my tax year 2017 electronically filed income tax return. Check this box only if you are entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below. Spouse's signature ► Date ► Practitioner PIN Method Returns Only - continue below Part III I Certification and Authentication - Practitioner PIN Method Only ERO's EFIN/PIN. Enter your six•digit EFIN followed by your frve•digit self. selected PIN. Don't enter all zeros I certify that the above numeric entry is my PIN, which is my signature for the tax year 2017 electronically filed income tax return for the taxpayer(s) indicated above. I confirm that I am submitting this return in accordance with the requirements of the Practitioner PIN method and Pub. 1345, Handbook for Authorized IRS e-Ile Providers of Individual Income Tax Retums. 1 3 7 6 9 9 1 3 3 4 9 ER0's signature OP. DAVID WEISS CPA, PLLC Date ► 719990 11-10.17 ERO Must Retain This Form - See Instructions Don't Submit This Form to the IRS Unless Requested To Do So INA For Paperwork Reduction Act Notice, see your tax return instructions. Form 8879 (2017) EFTA00792002
Tax Year 2017 e-file Jurat/Disclosure for Form 1040, 1040A, 1040EZ, or 1040NR using Practitioner PIN method (with or without Electronic Funds Withdrawal) ERO Declaration I declare that the information contained in this electronic tax return is the information furnished to me by the taxpayer. If the taxpayer furnished me a completed tax return, I declare that the information contained in this electronic tax return is identical to that contained in the return provided by the taxpayer. If the furnished return was signed by a paid preparer, I declare I have entered the paid preparer's identifying information in the appropriate portion of this electronic return. If I am the paid preparer. under the penalties of perjury I declare that I have examined this electronic return, and to the best of my knowledge and belief. it is true. correct. and complete. This declaration is based on all information of which I have any knowledge. ERO Signature I am signing this Tax Return by entering my PIN below. ERO's PIN 13769913349 (enter EFIN plus 5 self-selected numerics) Taxpayer Declarations Perjury Statement Under penalties of perjury. I declare that I have examined this return and accompanying schedules and statements. and to the best of my knowledge and belief, they are true, correct and accurately list all amounts and sources of income I received during the tax year. Declaration of preparer (other than the taxpayer) Is based on all information of which the preparer has any knowledge. Consent to Disclosure I consent to allow my Intermediate Service Provider. transmitter, or Electronic Return Originator (ERO) to send my retum/form to IRS and to receive the following information from IRS: a) an acknowledgment of receipt or reason for rejection of transmission: b) the reason for any delay in processing or refund: and. c) the date of any refund. I am signing this Tax Return and Electronic Funds Withdrawal Consent, If applicable, by entering my Self-Select PIN below. Taxpayers PIN: 49816 Date 10102018 Spouse's PIN: 71998e 04-01.17 EFTA00792003
Form 114a Department of the Treasury Financial Crimes Enforcement Network (FinCEN) I May 2015 Record of Authorization to Electronically File FBARs (See instructions below for completion) Do not send to FinCEN. Retain this form for your records. ANASTAS20170001 The fomi 114a may be digitally signed Part I I Persons who have an obligation to file a Report of Foreign Bank and Financial Accounts) 1. Owner last name or entity's legal name SIROOCHENKO 2. Owner first name ANASTASIYA 3. Owner 4. Spouse last name Of jointly filing FBAR • see instructions below) 5. Spouse first name 6. Spouse Vwe declare that Vwe have provided information concerning 1 (enter number of accounts) foreign bank and financial account(s) for the filing year ending December 31. 2017 to the preparer listed in Part II: that this information is to the best of my/our knowledge true. correct. and complete: that Vwe authorize the preparer listed in Part II to complete and submit to the Financial Crimes Enforcement Network (FriCEN) a Report of Foreign Bank and Fnancial Accounts (FBAR) based on the information that Vwe have provided: and that Vwe authorize the preparer listed in Part II to receive information from FinCEN. answer inquiries and resolve issues relating to this submission. Vwe acknowledge that. notwithstanding this declaration, it is my/our legal responsibility, not that of the preparer listed in Part II. to timely file an FBAR if required by law to do so. 7. Owner signature (Authorized representative if entity) 8. Date 9. Owner or entity TIN *** -** -9816 10. TIN a type b c Li F' OForegn EIN SSWITIN MM DD YYYY 11. Spouse signature 12. Date 13. Spouse TIN 14. TIN a Li EIN type b 0 SSN/ITIN c 0 Foreign MM DD YYYY Part II I Individual or Entity Authorized to File FBAR on behalf of Persons who have an obligation to tile. 15. Preparer last name WEISS 16. Preparer first name DAVID 17. Preparer 18. Preparer PTIN P00962062 19. Address 183 MADISON AVE SUITE 803 20. City NEW YORK 21. State NY 22. ZIP/postal code 10016-4403 23. Country code US 24. Preparers (item 15) employers (En ity) name DAVID WEISS CPA, PLLC 25. Employer EIN **-***2756 26. Preparers ignature DAVID WEISS Instructions for completing the FBAR S gnature Authorization Record This record may be completed by the individual or entity granting such authorization (Part I) OR the individuaVentity authorized to perform such services. The completed record must be signed by the individual(s)rentity grant ng the authorization (Part I) and the individuaVentity that will file the FBAR. The Preparer/filing entity must be registered with FinCEN BSA E•File system. (See http://bsaefiling.fincentreas.gov/main.html for registration). Read and complete the account owner statement in Part I. To authorize a third party to file the Foreign Bank and Financial Accounts Report (FBAR), the account owner should complete Part I. items 1 through 3 (as required), sign and date the document in Part I. items 7/8 and complete items 9 and 10. Item 7 may be digitally signed. Accounts Jointly Owned by Spouses (see exceptions in the FBAR instructions) If the account owner is filing an FBAR jointly with his/her spouse. the spouse must also complete Part I. items 4 through 6. The spouse must also sign and date the report in items 11/12. (item 11 may be digitally signed) and complete keens 13 and 14. A third party preparer may be one of the spouses of the jointly owned foreign account. In this case, both spouses must complete Part I of form 114a in its entirety. The third party preparer (spouse) that will file the FBAR on behalf of both spouses will complete Part II in its entirety (do not use such terms as see above, or same as item number )0, Complete Part II. items 15 through 18 with the preparer's information. The address, items 19 through 23, is that of the prepare( or the preparer's employer if the preparer is an employee. Record the employer's information (if any) in items 24 and 25. If the preparer does not have a PTIN. leave item 18 blank. The third party preparer must sign in item 26 (digital signature acceptable) of Part II indicating that the FBAR will be filed as directed by the authorizing authority. The person(s) listed in Part I, and the person listed in Part II as authorized to file on behalf of the person(s) listed in Part I. should retain copies of this record of authorization and the filing itself• both for a period of 5 years. See 31 CFR 1010.430(d). DO NOT SEND THIS RECORD TO FinCEN UNLESS REQUESTED TO DO SO. 720011 0441.17 Rev. 10.7 May 21.2015 EFTA00792004
ENCLOSE A CHECK FOR $500000, PAYABLE TO THE UNITED STATES TREASURY. INCLUDE YOUR SOCIAL SECURITY NUMBER, DAYTIME PHONE NUMBER, AND THE WORDS "2017 FORM 4868" ON YOUR CHECK. MAIL AS SOON AS POSSIBLE TO: INTERNAL REVENUE SERVICE CENTER III. BOX 37009 HARTFORD, CT 06176-7009 718711 06.15.17 • DETACH HERE • 4868 Department Otte, Traaluy Intornal Inryinnun Snrvictr Fix Cale Application for Automatic Extension of Time To File U.S. Individual Income Tax Return ysw 7017 a caw tar year nngnring 2017, andln0 2017 Part I I Identification 1 War nannIal ANASTASIYA SIROOCHENKO 288 WEST 4TH ST NEW YORK, NY 10014 2 Yaw nodal **Curtly meta 3 $00ufra's facial Sneurily note *** -** -9816 Part II Individual Income Tax 4 Estimate of total tax liability for 2017 547,000. 5 Total 2017 payments 47,000. 6 Balance due. Subtract line 5 from line 4 500,000. 7 Amount you are paying Ile' 500,000. 8 Check here if you are 'out of the country and a U.S. citizen or resident ill. LJ 9 Check bona ll you 100 Form 11)4C.IR a 1040NR.E7 and did not Wan* ..pops as an employee subjact to IJ S Inconur tax voihnokling i. LJ ********* YF SIRO 30 0 201712 670 EFTA00792005
2018 Estimated Tax Worksheet Keep for Your Records 1 Adjusted gross income you expect in 2018 (see instructions) 2a Deductions • If you plan to itemize deductions, enter the estimated total of your Itemized deductions. These include qualifying home mortgage interest, charitable contributions, state and local taxes (up to $10,000). and medical expenses in excess of 7.5% of your income.' • If you dont plan to itemize deductions. enter your standard deduction. b If you qualify for the deduction under section 199A, enter the estimated amount of the deduction you are allowed on your qualified business income from a qualified trade or business c Add lines 2a and 2b ► 3 Subtract line 2c from line 1 4 Tax. Figure your tax on the amount on line 3 by using the 2018 Tax Rate Schedules. Caution: if you wilt have qualified dividends or a net capita( gain, or expect to exclude or deduct foreign earned Income or housing, see Worksheets 2-5 and 2-6 in Pub. 505 to figure the tax 6 Alternative minimum tax from Form 6261 or included on Form 1040A, line 28 6 Add lines 4 and 5. Add to this amount any other taxes you expect to include in the total on Form 1040. line 44 7 Credits (see instructions). Do not inckide any income tax withholding on this line 8 Subtract line 7 from fine 6. If zero or less, enter to - 9 SelforoploymeM tax (see instructions) 10 Other taxes (see instructions) 11a Add lines 8 through 10 b Earned income credit, additional child tax credit, fuel tax credit, net premium tax credit, refundable American opportunity credit, and refundable credit from Form 8885 c Total 2018 estimated tax. Subtract line 11b from line 11a. If zero or less. enter 41. Pio 12a Multiply line 11c by 90% (66 2/3% for farmers and fishermen) 02al 593,273. b Required annual payment based on prior year's tax (see instructions) 112b I 612,339. c Required annual payment to avoid a penalty. Enter the smaller of line 12a or 12b ► Caution: Generally, if you do not prepay (through income tax withholding and estimated ax payments) at least the amount on fine 12c, you may owe a penalty for not paying enough estimated tax. To avoid a penalty, make sure your estimate on line f is Is as accurate as possible. Even if you pay the required annual payment, you may still owe tax when you file your return. If you prefer, you can pay the amount shown on line tic. For details, see chapter 2 of Pub. 505. 13 Income tax withheld and estimated to be withheld durng 2018 (including income tax withholding on pensions, annuities, certain deferred income, etc.) 14a Subtract line 13 from line 12c ADJUSTED TO: 14a 593,280. Is the result zero or less? 0 Yes. Stop here. You are not required to make estimated tax payments. CE No. Go to line 14b. b Subtract Ina 13 from Ina 11c 1 1,540,763. 2a 32,000. 2b 2c 3 32,000. 1,508,763. 4 523,932. 5 6 7 8 9 10 11a 523,932. 523,932. 58,046. 11,295. 593,273. 11b 11c 593,273. 12c 593,273. 13 14b 593,273. Is the result less than $1,000? 0 Yes. Stop here. You are not required to make estimated tax payments. M No. Go to line 15 to figure your required payment. 16 If the first payment you are required to make is due April 17. 2018. enter 1/4 of Inc, 14a (minus any 2017 overpayment that you are applying to this instalkoent) here, and on your estimated tax payment vouchers) if you are paying by check or money order 'When figuring your 2018 estimated taxes, and estimating your deductions, you might want to take into account that the standard deduction for all filing statuses has increased substantially and many itemized deductions have been eliminated or the deduction amount has been reduced. See the items under What's New. AMOUNT ALREADY PAID 16 Form 1040-ES (2018) 200,000. 7104D1 03-06.1$ EFTA00792006
0 1040-ES Depanment al the Treasury internal Revenue Service I2018 Estimated Tax Payment 1 Voucher OTOS No 1545.00TA File only if you are making a p yment of estimated tax by check or money order. Mail this voucher with your check or money order payable to 'United States Treasury.' Write your social security number a d '2018 Form 1040-ES' on your check or money order. Do not send cash. Enclose, bu do not staple or attach, your payment with this voucher. Your first name and initial ANASTASIYA Your last name S IROOCHENKO Caiendaryear - Due April 17, 2018 Amount of estimated tax you are paying by check or money order. ts 0.1 our social security number ***—**-9816 It pint payment, complete tor spouse Spouse's first name and initial Spouse's last name Spouse's social security number Address (number, street, and apt. no.) 288 WEST 4TH ST City, state, and ZIP code. (If a foreign address, enter city, also complete spaces below.) NEW YORK, NY 10014 Foreign country name Foreign province/county Foreign postal code LHA For Privacy Act and Paperwork Reduction Act Notice, see instructions. CUT HERE MAIL TO: INTERNAL REVENUE SERVICE CENTER III. BOX 37007 HARTFORD, CT 06176-7007 710411 03-06-15 EFTA00792007
€ 1040-ES 0 Dopanment of the lo:as..0 WormMovenuoSovice 12018 Estimated Tax Payment 2 Voucher cus No, 1545.0074 ile only if you are making a payment of estimated lax by check or money order. Mail this oucher with your check or money order payable to 'United States Treasury.- Write our social security number and '2018 Form 1040-ES' on your check or money order. Do not send cash. Enclose, but do not staple or attach, your payment with this voucher. Your first name and initial ANASTASIYA Your last name S IROOCHENKO Calendaryear - Due June 15, 2018 Amount of estimated tax you are paying by check or money order. IfSour social security2 9 O, O number0 0 1 ***_**_9816 It joint payment, complete tor spouse Spouse's first name and initial Spouse's last name Spouses social security number Address (number, street, and apt. no.) 288 WEST 4TH ST City, state, and ZIP code. (If a foreign address, enter city, also complete spaces below.) NEW YORK, NY 10014 Foreign country name Foreign province/county Foreign postal code LHA For Privacy Act and Paperwork Reduction Act Notice. see I structlons. CUT HERE MAIL TO: INTERNAL REVENUE SERVICE CENTER III. BOX 37007 HARTFORD, CT 06176-7007 710412 03-06.15 EFTA00792008
€ 1040-ES 0 oopmmentottnah“, wammweivesaidep 2018 Estimated Tax Payment dr) Voucher 0 O&M W. 1545.0074 File only if you are making a payment of estimated tax by check or money order. Mail this voucher with your check or money order payable to 'United States Treasury? Write your social security number and '2018 Form 1040-ES' on your chec or money order. Do not send cash. Enclose, but do not staple or attach, your payment with this voucher. Calendar year -Due Sept. 17, 2018 Amount of estimated t by check or money order. you are paying 0. our social security number ***—** -9816 Your first name and initial ANASTASIYA Your last name S IROOCHENKO It pint payment, complete tor spouse Spouse's first name and initial Spouse's last name Spouse's social security number Address (number, street, and apt. no.) 288 WEST 4TH ST City, state, and LIP code. (If a foreign address, enter city, also complete spaces below.) NEW YORK, NY 10014 Foreign country name Foreign province/county Foreign postal code LHA For Privacy Act and Paperwork Reduction Act Notice, see I structions. CUT HERE MAIL TO: INTERNAL REVENUE SERVICE CENTER III. BOX 37007 HARTFORD, CT 06176-7007 710471 03-06-15 EFTA00792009
€ 104O-ES 0 Depanment of the Treaty 2018 Estimated Tax Payment A Voucher 01101 No. 15400074 File only if you are making a p yment of estimated tax by check or money order. Mail this voucher with your check or m ney order payable to 'United States Treasury.' Write your social security number a d '2018 Form 1040-ES' on your check or money order. Do not send cash. Enclose, bu do not staple or attach, your payment with this voucher. Calendar year- Due Jan. 15, 2019 Amount of estimated tax you are paying by check or money order. 400,0001 Your first name and initi I Your last name ANASTASIYA IROOCHENKO our social security number ***_**_9816 It joint payment, complet tor spouse Spouses first name and Mal Spouse s last riattt Spouses social security number Address (number, street, and apt. no.) ea. 288 WEST 4TH ST City, state, and ZIP code. (If a foreign address, enter city, also complete spaces below.) NEW YORK, NY 10014 Foreign country name Foreign province/county Foreign postal code LHA For Privacy Act and Paperwork Reduction Act Notice, see instructions. CUT HERE MAIL TO: INTERNAL REVENUE SERVICE CENTER III. BOX 37007 HARTFORD, CT 06176-7007 710422 03-06.15 EFTA00792010
1040 Form 1040-ES - Self-Employment Tax Worksheet Taxpayer Spouse 1. Estimated income and profits subject to self-employment tax 1,572,867. 2. Multiply the amount on line 1 by .9235 1,452,543. 3. Muttiply the amount on line 2 by .029 42,124. 4. Social security tax maximum income 128,400. 5. Estimated wages subject to social security tax 6. Subtract line 5 from tine 4 128,400. 7. Enter the smaller of tine 2 or line 6 128,400. 8. Multiply the amount on line 7 by .124 15,922. 9. Add line 3 and line 8 58,046. 10. Total estimated self-employment tax 58,046. Adjusted Gross Income Worksheet Mar Adjusted gross income 2017 1,540,837. Add back: deductible part of year self-employment tax 2017 28,949. Change in adjusted gross Income Adjustment to capital gains/losses Minus: deductible part of year estimated self-employment tax 2018 29,023. Estimated year adjusted gross income IUfg 1,540,763. O 70205 03.06-18 EFTA00792011
1040 Form 1040-ES - Additional Medicare Tax Liability Worksheet Earned Income Calculation 1 Enter taxpayer's net self employment earnings (but not less than zero) plus medicare wages 1,452,543. 2 If married filing jointly, enter spouse's net self employment earnings (but not less than zero) plus medicare wages 3 Add lines 1 and 2 1,452,543. 4 Enter $200,000 ($250,000 if married filing jointly or $125,000 if married filing separately) 200,000. 5 Subtract line 4 from line 3. If less than zero, no additional medicare tax is due 1,252,543. Multiply line 5 by .009. This is your Additional Medicare Tax liability. Enter the result here and on Form 1040ES, line 12 11,273. Investment Income Calculation 1 Net investment income 2 Net gain from the sale of assets. Do not include any gain from the sale of assets used in a trade or business that is not a passive activity. Do not enter less than zero 3 Add lines 1 and 2 4 Enter your adjusted gross income 5 Enter any amounts from Form 2555, lines 45 and 50 or Form 2555EZ, line 18 6 Add lines 4 and 5 7 Enter $200,000 ($250,000 if married filing Jointly or $125,000 if married filing separately) 200,000. 8 Subtract line 7 from line 6 9 Enter the lesser of line 3 or fine 8 10 Multiply line 9 by 3.8% (.038). This Is your net Investment tax. Enter the result here and on Form 1040ES, line 12 585. 585. 1,540,763. 1,340,763. 585. 22. m02 r0 0401.17 EFTA00792012
E 1040 U.S. Individual Income Tax Returnlr a 2017 XTENSIO oke No. 1545.0074 II GRANTED TO 10/15/18 Pis Nele Only - Do nal write& staple iota epode Fot me y 1-044 31. 20 17, or obx. ter, year Mon nng 20W. es ding 20 See generate 1116truCbons. Your first name and initial ANASTASIYA Last name SIROOCHENKO 'ow social security number ***4**49816 If a joint return, spouse's first name and initial Last name scettws social socially number liome address (number and street). If you have a 288 WEST 4TH ST ox, see instructions- I Apt. no. A Mansura the SSW) above and on One 6c ore wrap. City. town or pool *Moo stole. and ZIP code. It you have a anelgn acittoess. So correcene yams below. NEW YORK, NY 10014 Presidential blection Lampolge Check hate II you, or your spouse it tiling jointly wanl $310 go to this fund Chianti g o box below Foreign country name Foreign province/state/county Foreign postal code will not change your tax or rotund. You C Spouse Filing Status Check only one box. 1 IX.J Single 2 Q Married filing jointly (even if onl one had income) 3 Q Married filing separately. Enter spouses SSN above and full name here. ► 6a Yourself. If someone can claim you as a dependent, do not check box 6a b O Spouse c Dependents: (t) Fast name 4 LJ Head of household (with qualifying person). If the qualifying person i a child but not your dependent, enter this child's name he e. ► 5 ILI Qualifying widow(er) (see instructions) Exemptions If more than four dependents, see instructions and ri check here So d Total number of exemptions claimed Income 7 Wages, salaries, tips, etc. Attach Form(s) W-2 ' 7 8a 8a Taxable interest Attach Schedule 8 it required Attach Form(s) W-2 here. Also b 9a Tax-exempt interest Do not include on line 8s. 18b Ordinary dividends. Attach Schedule B if required I 9a attach Forms b Qualified dividends 19b W-2G and 10 Taxable refunds, credits, or offsets of state and local income taxes 10 1099-R if tax was withheld. 11 Alimony received 11 12 Business income or (loss). Attach Schedule C or C-EZ 12 13 Capital gain or (loss). Attach Schedule D U required. If not required, ohm* here 13 If you did not get a W-2, 14 Other gains or (losses). Attach Form 4797 14 see instructions. 15a 'FLA distnbutions [15a b Taxable amount 15b 16a Pensions and annuities 16a I b Taxable amount 16b 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 17 18 Farm income or (loss). Attach Schedule F 18 19 Unemployment compensation 19 20a Social security benefits 120a I I b Taxable amount 20b 21 Other income. List type and amount 21 22 Combine the amounts in the tar right column for lines 7 through 21. This is /our total Income ► 22 23 Educator expenses 23 Adjusted 24 Conan business expenses of reservist. patterning artists. and rote-bans gennmen1 officials Attach Form 2106 or 2106-EZ 24 Gross 25 Health savings account deduction. Attach Form 8889 25 Income 26 Moving expenses. Attach Form 3903 26 27 Deductible part of self-employment tax. Attach Schedule SE 27 28,949. 28 Self-employed SEP, SIMPLE, and qualified plans 28 29 Self-employed health insurance deduction 29 3,836. 30 Penalty on early withdrawal of savings 30 31a Alimony paid b Recipient's SSN 31a 32 IRA deduction 32 33 Student loan interest deduction 33 34 Tuition and fees. Attach Form 8917 34 35 Domestic production activities deduction. Attach Form 8903 35 36 Add lines 23 through 35 36 710301 02-22O8 37 Subtract line 36 from line 22. This is your adjusted gross Income 37 Last name (2)Orneridenre Serial security number O.04endenEs relatkentalp 10 you Boxes aced on Ea and Ea No of children thig 6c ho. min age 17 p lend with you 1004019 NI hr4 did not Ma with grardt you due tO Ovate a Separation Pee InStruCt1C081 Dependents ore 6c not entered above Add numbers on lines._ above P' 755. 1,572,867. 1,573,622. 32,785. 1,540,837. LHA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate Instructions. F-tym 10400017, EFTA00792013
Fam1040(mm ANASTAS I YA SIROOCHENKO ***-**-9816 Page 2 Tax and Credits 38 Amount from 39a Check ii: b if your spouse line 37 (adjusted gross income) Total boxes checked llo, 39a here lb, 39b 38 1 , 540 , 8 37 . 0 You were born before January a 1953, O Blind. 1v Dan on lor . ochicti • People vino oho* any box Spouse was born before January 2, 1953, Blind. J itemizes on a separate return or you were a dual-status alien, check on line 3ga ig 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin) 40 198,261. 39b inwho can 41 1,342,576. be darned DS a 41 Subtract line 40 from line 38 *attenant see 42 0 . InStructI d onia. 42 Exemptions. If line 38 is $156,900 or less, multiply $4,050 by the number on line 6d. Otherwise, see inst 43 Taxable income. Subtract tine 42 from line 41.11 line 42 is more than line 41_,_ enter -0- 43 1,342,576. 44 Tax. Check if any from: a Form(s)Et814 b Form 4972 c LJ 44 487,479. 45 Alternative minimum tax. Attach Form 6251 45 • hi °Minh' 46 Excess advance premium tax credit repayment Attach Form 8962 46 Single or Myriad Nog somway. 47 Add lines 44, 45, and 46 ,,, ,,, ,, , bi. 47 487,479. 48 46.3.50 48 Foreign tax credit Attach Form 1116 if required Mantled Ming jointly of 49 Credit for child and dependent care expenses. Attach Form 2441 49 50 Quadra/Ng wIdowlari. 50 Education credits from Form 8863, line 19 51 SI2.7C0 51 Retirement savings contributions credit Attach Form 8880 Stead of household. 52 Child tax credit Attach Schedule 8812, it required 52 53 $9.3.50 53 Residential energy credits. Attach Form 5695 54 Other credits from Form' a 3800 b Q 8801 c CI 54 55 Add lines 48 through 54. These are your total credits 55 56 Subtract line 55 from line 47. If line 55 is more than line 47, enter -0- IIII• At ► 56 487,479. 57 Self-employment tax. Attach Schedule SE 57 57,897. Other 58 Unreported social security and Medicare tax from Form: a04137 608919 58 Taxes 59 Additional tax on IRAs, other qualified retirement plans, et. Attach Form 5329 if required 59 60a Household employment taxes from Schedule H 60a b First-time homebuyer credit repayment Attach Form 5405 it required 60b 61 Health care: individual responsiaility (see instructions) Full-year coverage El 61 62 Taxes from: a Fl Form 8959 b II Form 8960 c Q last: enter code(s) STATEMENT 3 62 11,295. 63 Add lines 56 through 62. This is your total tax Olo 63 556,671. Payments 64 Federal income tax withheld from Forms W-2 and 1099 64 65 2017 estimated tax payments and amount applied from 2016 return 65 47,000. STATEMENT 6 Kyouharea qualityhg cloud, attach Schedule FIG. a Earned income credit (EIC) l combat pay election 1661, 66a b Nontaxable 67 Additional 67 child tax credit Attach Schedule 8812 68 American opportunity credit from Form 8863, line 8 68 69 Net premium tax credit Attach Form 8962 69 70 Amount paid with request for extension to file 70 500,000. 71 Excess social security and tier 1 RRTA tax withheld' 71 72 Credit for federal tax on fuels. Attach Form 4136 72 73 Credits from Form: a02439 b gy•yrysC 08885 d0 73 74 Add lines 64, 65, 66a, and 67 through 73. These are your total payments Ito 74 547,000. Refund 75 If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid 76 m.,0(usl it, 76a Amount of line 75 you want refunded to you. It Form 8888 is attached, check here ► Tea sea III• b:tAill Ili" c TWO IMI OTolarg I1 Sating, Illih d ZIT: r'''''"`u*" 77 Amount of line 75 you want applied to your 2018 estimated tax I. I 77 I Amount 78 Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions lb. 78 9,671. You OWe 79 Estimated tax penalty (see instructions) I 79 I 0 . Third Party Do you want to allow another person to discuss this return with the IRS (see instructions)? I X I Yes Complete DelOn:. tor Designee F„',92,7"110.DAVID WEISS Pirlii0212 -695 -5771 en6j2Iiii.433491 Personal KJ I.. Sign &evil:rains of mug'. I &dm NI I hoop:rinal VERO/Map acconoanymmtoOlicsaynotr d a occu ltmenpa lS. tion inft the besiol nylnookcIpt and bile hey aro Pue.correct and at wady Id al arm gnis and SOIICIS 0trainImam' dragIto tax year. °Motion ol 'cepa (Mho dun tow ba ) is ndonall nformiboo of ,cosh rower has ny aytime phone Meeker numb., D Here YOU' Orehre Date Jommiwra Sea InsruCtiong I T DEALER Keep a COpy Spousal, Signature. IT a phi retain, both must sir barn I SpnrM'sOcaapa on tot yew record& If the RS sent you en Wendy Protection Pal enter ti hate Preparers stratum hrinTaTilla groprew's name Paid Preparer DAVID WEISS DAVID WEISS Use Only fem'snama Os DAVID WEISS CPA, PLLC Date Choc* I I sell-employed PTIN P00962062 1 777.1W4* - * * * 2 7 5 6 183 MADISON AVE SUITE 803 primer* 212-695-5771 now202-2218 FIM.CA"cdC Oh NEW YORK, NY 10016-4403 SEE STMT FOR INT AND PEN NOT INCLUDED. TOTAL DUE $9916 EFTA00792014
F.. 2210 Depattmem ol lea TIO0SUY Internal Revenue Service Underpayment of Estimated Tax by Individuals, Estates, and Trusts 80 Go to www.irs.gov/Form2210 for instructions and the latest information. OP, Attach to Form 1040, 1040A, 1040NR, 1040NR-EZ, or 1041. 00.WW.1545.00n 2017 MIACMIOM SOCIWMONA06 Name(s) shown on tax r turn ANASTASIYA SIROOCHENKO Identifying number ***-**-9816 Do You Have To File Form 2210? Yes Complete Ines 1 through 7 below. Is line 7 less than $1.000? Don't file Form 2210. You dont owe a penalty. Yes lir No Complete lines 8 and 9 below. Is line 6 equal to or more than line 9? You don't owe a penalty. Don't file Form 2210 (but if box E in Part II applies, you must file page 1 of Form 2210). Yes No You may owe a penalty. Does any box in Part II below apply? You must file Form 2210. Does box Et, C, or D in Part II apply? Don't file Form 2210. You aren't required to figure your penalty because the IRS will figure it and send you a bill for any unpaid amount. If you want to figure it. you may use Part III or Part IV as a worksheet and enter your penalty amount on your tax return, but don't file Form 2210. Yes ► You must figure your penalty. You aren't required to figure your penalty because the IRS will figure it and send you a bil for any unpaid amount. If you want to figure it. you may use Part III or Part W as a worksheet and enter your penalty amount on your tax retum, but file only page 1 of Form 2210. Part I Required Annual Payment 1 Enter your 2017 tax alter credits from Form 1040, line 56 (see instructions it not filing Form 1040) 2 Other taxes, including self-employment tax and, it applicable, Additional Medicare Tax and/or Net Investment Income Tax (see instructions) irt 3 Refundable credits, including the premium tax credit (see instructions) 4 Current year tax. Combine lines 1,2, and 3. If less than $1,000. stop; you don't owe a penalty. Don't file Form 2210 5 Multiply line 4 by 90%(0.90) I 5 I 501,004. 6 Withholding taxes. Don't include estimated tax payments (see instructions) 7 Subtract line 6 from line 4. If less than $1,000, stop; you don't owe a penalty. Don'tfile Form 2210 8 Maximum required annual payment based on prior years tax (see instructions) 9 Required annual payment. Enter the smaller of line 5 or line 8 Next Is line 9 more than line 6? No. You don't owe a penalty. Don't file Form 2210 unless box E below applies. M Yes You may owe a penalty, but don't file Form 2210 unless one or more boxes in Part II bebw applies. • If box B, C, or D applies, you must figure your penalty and file Form 2210. • If box A or E applies (but not B, C, or D) file only page 1 of Form 2210. You aren't required to figure your penalty; the IRS will figure it and send you a bill for any unpaid amount If you want to figure your penalty, you may use Part III or IV as a worksheet and enter your penalty on your tax return, but file only page 1 of Form 2210. 1 2 3 4 4 87,479. 69,192. 556,671. 6 7 8 9 556,671. 41,820. 41,820. I Part III Reasons for Filing. Check applicable boxes. If none apply, don't file Form 2210. A Li You request a waiver (see instructions) of your entire penalty. You must check this box and file page 1 of Form 2210, but you aren't required to figure your penalty. B EJ You request a waiver (see instructions) of part of your penalty. You must figure your penalty and waiver amount and file Form 2210. C M Your income varied during the year and your penalty is reduced or eliminated when figured using the annualized income installment method. You must figure the penalty using Schedule Al and file Form 2210. D C Your penalty is lower when figured by treating the federal income tax withheld from your income as paid on the dates it was actually withheld, instead of in equal amounts on the payment due dates. You must figure your penalty and file Form 2210. E Q You filed or are filing a joint return for either 2016 or 2017, but not for both years, and line 8 above is smaller than line 5 above. You must file page 1 of Form 2210. but you aren't required to figure your penalty (unless box 8, C, or D applies). LHA For Paperwork Reduction Act Notice, see separate Instructions. Form 2210 (2017) 7125W01-05-18 EFTA00792015
Form2210(2M7) ANASTASIYA SIROOCHENKO Regular Method (See the instructions if you are filing Form 1040NR or 1040NR-EZ.) Section A - Figure Your Underpayment Payment Due Dates (a) 4/15117 (b) 6115/17 (c) 9/15117 (d) 1/15/18 18 Required Installments. If box C in Part II applies, enter the amounts from Schedule Al, line 25. Otherwise, enter 25%(0.25) of line 9, Form 2210, in each column 19 Estimated lax pad and tax Withheld. For craumn (p)ant/. add SAW the amount from lino 19 on line 23. 2 line 19 Is usual top more than line 18 for all payment wind& Stop IlenX you dull oh. a Penalty. Don't file Form 2210 unless you checked a box In Part II Complete lines 20 through 26 of one column before going to line 20 of the next column. 20 Enter the amount, it any, from line 26 in the previous column 21 Add fines 19 and 20 22 Add the amounts on limo 24 and 251n dm molars column 23 Subtract line 22 from line 21. If zero or less, enter -0-. For column (a) only, enter the amount from fine 19 24 If line 23 is zero, subtract line 21 from line 22. Otherwise, enter -0- 25 Underpayment. If line 18 is equal to or more than line 23, subtract line 23 from line 18. Then go to line 20 of the next column. Otherwise, go to line 26 ► 26 Overpayment. If line 23 is more than line 18, subtract line _ 18 from line 23. Then go to line 20 of the next column 18 41,820. 19 47,000. 20 21 47,000. 22 23 0 . 0 . 0 . 47,000. 24 25 26 ***-**-9816 Page3 c ion F3 - Figure the Penalty (Use the Worksheet for Form 2210. Part IV. Section 8 Figure the Penalty in the instructions.) 27 Penalty. Enter the total penalty from line 14 of the Worksh et for Form 2210. Part IV. Section B - Figure the Penalty. Also include this amount on Form 1040. line 79; Form 1040A, line 51; Form 1040NR, line 76; Form 1040NR-EZ. line 26; or Form 1041, line 26. Don't file Form 2210 unless you checked a box In Part II 27 0. Form 2210(2017) 712491 01425-18 EFTA00792016
Form 2210 (2017) ANASTASIYA SIROOCHENKO ***-**-9816 Page 4 Schedule Al - Annualized Income Installment Method (See the instructions.) Estates and trusts, don't use the period ending dates shown to the (a) (b) (c) (d) right. Instead, use the following: 2/28/17, 4/30/17, 7/31/17, and 1/1/17 - 3/31/17 111/17 - 5/31/17 111/17 - 8131117 1/1/17 - 12/31/17 11/30/17. Part I I Annualized Income Installments 1 Enter your adjusted gross income for each period (see instructions) (Estates and trusts, enter your taxable income without your exemption for each period) 1 0. 0. 0.1,540,837. 2 Annualization amounts. (Estates and trusts, see instructions) 3 Annualized income. Multiply line 1 by line 2 4 If you itemtre, enter itemized deductions for the period shown in each column. All others enter -0-, and skip to line 7. Exception: Estates and trusts, skip to line 9 and enter amount from line 3 5 Annualization amounts 6 Multiply line 4 by tine 5 (see instr. if line 3 is more than $156,900) , 7 In each column, enter the full amount of your standard deduction from Form 1040, line 40, or Form 1040k line 24. (Form 1040NR or 1040NR-EZ filers, enter -0-. Exception: Indian students and business apprentices, see instructions.) 8 Enter the larger of line 6 or ine 7 2 4 2.4 1.5 1 3 0. 0. 0.1,540,837. 4 59,160. 98,600. 157,760. 198,261. 5 4 2.4 1.5 1 6 236,640. 236,640. 236,640. 198,261. 7 0. 0. 0. 6,350. 8 0. 0. 0. 198,261. 9 Subtract line 8 from line 3 10 In each column, multiply $4,050 by the total number of exemptions claimed (see instructions if line 3 is more than $156,900). (Estates, trusts, and Form 1040NR or 1040NR-EZ filers, see instructions.) , 11 Subtract line 10 from line 9. if zero or less, enter -0- 12 Figure your tax on the amount on line 11 (see instructions) 13 Self-employment tax from line 34 (complete Part II below) 14 Enter other taxes for each payment period including, if applicable, Additional Medicare Tax and/or Net Investment Income Tax 9 0. 0. 0.1,342,576. 10 4,050. 4,050. 4,050. 0. 11 . 0. 0. ,342,576. 12 . 0 . 0. 487,479. 13 0. 0. 0. 57,897. 14 0 . 0 . 0. 11,295. 15 Total tax. Add lines 12, 13, and 14 16 For each period, enter the same type of credits as allowed on Form 2210, Part I, lines 1 and 3 (see instructions) 17 Subtract line 16 from line 15. If zero or less, enter -0- 18 Applicable percentage 19 Multiply line 17 by line 18 Complete lines 20-25 of one column before going to line 20 of the next column. 20 Enter the total of the amounts in all previous columns of line 25 21 Subtract line 20 from line 19. If zero or less, enter -0- 22 Enter 25% (0.25) of 9 on page 1 of Form 2210 in each column 23 Subtract line 25 of the previous column from line 24 of that column 24 Add lines 22 and 23 25 Enter the smaller of tine 21 or line 24 here and on Form 2210, Part IV, line 18 ► 15 0 . 0 . 0. 556,671. 16 0 . 0 . 0 . 0 . 17 0 . 0 . 0. 556,671. 18 22.5% 45% 67.5% 90% 19 0. 0. 0. 501,004. 20 0 . 0 . 0 . 21 0 . 0 . 0. 501,004. 22 10,455. 10,455. 10,455. 10,455. 23 10,455. 20,910. 31,365. 24 10,455. 20,910. 31,365. 41,820. 25 0. 0. 0. 41,820. nnua ize e - mp oymen Tax (Form 1040 and Form 1040NR filers only) 26 Net earnings from self-employment for the period (see instructions) 27 Prorated soc ial security tax limit 28 Enter actual wages for the period subject to social security tax or the 6.2% portion of the 7.65% railroad retirement (tier 1) tax. Exception: If you filed Form 4137 or Form 8919, see instructions 29 Subtract line 28 from line 27. If zero or less, enter -0- 30 Annualization amounts 31 Multiply line 30 by the smaller of line 26 or line 29 32 Annualization amounts 33 Multiply line 26 by line 32 34 Add lines 31 and 33. Enter here and on line 13 above ► 26 27 $31.800 $53.000 $84.800 $127,200 28 29 30 0.496 0.2976 C.'86 0.124 31 32 0.116 3.3696 3.3435 0029 33 34 M255101-0048 Form 2210 (2017) EFTA00792017
SCHEDULE A (Form 1040) Dooattmeni of the Toulon Internal Revenue Sorvico (99) itemized Deductions Iii. Go to www.irs.gov/ScheduleA for instructions and the latest Information. I"' Attach to Form 1040. Cullom It Wa are ralnaln A i'1 ni 'shard liana( kora on Form 4684 gee the Man tritons lot Imo 28 0/AR No. 1545.0074 2017 Anacnnini SegLeice No.IJI a., Nuns) shown on Earn 1040 ANASTASIYA SIROOCHENKO at Waal *Kuria nuraart *** -1** -:9816 Medical Caution: Do not include expenses reimbursed or paid by others. and 1 Medical and dental expenses (see instructions) 1 0 . Dental 2 Enter amount from Form 1040, line 38 12I Expenses 3 Multiply line 2 by 7.5% (0.075) 3 4 Subtract line 3 from line 1. If line 3 is more than line 1 enter -0. 4 Taxes You 5 State Paid a and FAI local (check only one Income taxes, or l box): SEE STATEMENT 7 5 214,641. 214,641. b 0 General sales taxes 6 Real estate taxes (see instructions) 6 7 Personal property taxes 7 8 Other taxes. List type and amount Illi. 8 9 Add lines 5 through 8 19 Interest 10 Home mortgage interest and points reported to you on Form 1098 10 You Paid 11 Home mortgage interest not reported to you on Form 1098. If paid to the person from whom you bought the home. see instructions and show that person's name. Identifying no.. and address P Note: t , 11 Your mortgage 12 Points not reported to you on Form 1098. See instructions for special rules interest 12 deduction may 13 Mortgage insurance premiums (see instructions) 13 be limited (see 14 Investment interest. Attach Form 4952 if required. See instructions 14 instructions). 15 Add lines 10 through 14 115 Gifts to 16 Gifts by cash or check If you made any gift of $250 or more, see instructions 16 22,000. STMT 8 22,000. Charity 17 Other than by cash or check. If any gift of $250 or more, see instructions. If you made a You must attach Form 8283 if over 5500 ..../ 17 gift and got a benefit for it, 18 Carryover from prior year 18 see instructions. 19 Add lines 16 through 18 , 19 Casualty and 20 Casualty or theft loss(es) other than net qualified disaster losses. Attach Form 4684 Theft Losses enter the amount from line 18 of that form. See instructions . . . . and 20 Job Expenses 21 Unreimbursed employee expenses - job travel, union dues. job education. etc. and Certain Attach Form 2106 or 2106•EZ if required. See instructions. Ill, Miscellaneous Deductions 21 22 Tax preparation fees 22 23 Other expenses • investment, safe deposit box, etc. Ust type and amount Pi' 23 24 Add lines 21 through 23 24 25 Enter amount from Form 1040, tine 38 1261 26 Multiply line 25 by 2% (0.02) 26 27 Subtract line 26 from line 24. If line 26 Is more than line 24. enter 43. 27 Other 28 Other • from list in instructions. Ust type and amount Pi. Miscellaneous Deductions 28 29 Is Total Form IMI 1040. line 38. over 5156.900? No. Your deduction is not limited. Add the amounts in the far right column for lines 4 through 28. Also. enter this amount on Form 1040. line 40. STMT 9 29 198,261. Itemized M Yes. Your deduction may be limited. See the Itemized Deductions Deductions Worksheet in the instructions to figure the amount to enter. 30 If you elect to itemize deductions even though they are less than your standard deduction. check here P n LHA rissoi 02.27.15 For Paperwork Reduction Act Notice, see the Instructions for Form 1040. Schedule A (Form 1040) 2017 EFTA00792018
SCHEDULE B (Form 1040A or 1040) Dopattmeni al the Troasesy Interns/ Revenue Seneice (99) hams} °AMUR, Interest and Ordinary Dividends ► Attach to Form 1040A or 1040. ► Go to www.Irs.gov/ScheduleB for instructions and the latest information. OMR No IS45.0374 2017 Allachmont Sequceico No.08 W BeCHayW ANASTASIYA SIROOCHENKO Part I Interest ***-**-9816 Note: If you received a Form 10991NT, Form 1099O1D, or substitute statement from a brokerage firm. list the firm's name as the payer and enter the total interest shown on that form. 1 List name of payer. If any interest is from a sellerfinanced mortgage and the buyer used the property as a personal residence, see the instructions and list this interest first. Also, show that buyer's social security number and address ► CHASE UNICREDIT BANK AUSTRIA AG 2 Add the amounts on line 1 3 Excludable interest on series EE and I U.S. savings bonds issued after 1989. Attach Form 8815 4 Subtract line 3 from line 2. Enter the result here and on Form 1040k or Form 1040 line 8a ► Amount 740. 15. 755. 3 4 755. Note: If line 4 is over $1,500, you must complete Part III Amount Part II Ordinary Dividends Note: If you received a Form 1099DIV or substitute statement from a brokerage firm. list the firm's name as the payer and enter the ordinary dividends shown on that form. Part III Foreign Accounts and Trusts 5 List name of payer ► 6 Add the amounts on line 5. Enter the total here and on Form 1040A. or Form 1040. line 9a Note: If line 6 is over $1,500, you must complete Part III. You must complete this past if you (a) had over $1.500 of taxable interest or ordinary dividends: (b) had a foreign account: or (c) received a distribution from. or were a grantor of. or a transferor to. a foreign trust. 7a At any time during 2017, did you have a financial interest in or signature authority over a financial account (such as a bank account, securities account, or brokerage account) located in a foreign country? See instructions If -Yes,' are you required to file FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR), to report that financial interest or signature authority? See FinCEN Form 114 and its instructions for filing requirements and exceptions to those requirements b If you are required to file FinCEN Form 114. enter the name of the foreign country where the financial account is located ► AUSTRIA 8 During 2017, did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust? 72751)1 1D-25.17 If 'Yes? you may have to file Form 3520. See instructions X L.HA For Paperwork Reduction Act Notice, see your tax return Instructions. Schedule B (Form 1040A or 1040) 2017 Yes X No X EFTA00792019
SCHEDULE C (Form 1040) Dvannurnio111)ohaasory Internal Revenue Soma. Wel mm0P0WWW Profit or Loss From Business (Sole Proprietorship) * Go to wairs.gov/ScheduleC for instructions and the latest information. *Attach to Form 1040, 1040NR, or 1041; partnerships generally must file Form 1065. OMR No 1545.0374 2017 Allachniont Se(Nolte No 09 ANASTASIYA SIROOCHENKO A Principal business or profession, including product or service (see instructions) ART DEALER C Business name. If no separate business name, leave blank. SUBLIME ART LLC E Business address (including suite or room no.) * 244 FIFTH AVE #1590 Social aecnmy comet, ISSN) ***_**_9816 B PO, coda Iron n lfuc:ana ► 453920 City, town or post office, state, and ZIP code NEW YORK, NY 10001 pEmple,wcwit.. **-***7860 F Accounting method: (1) L_I Cash (2) Lyi Accrual (3) Lj Other (specify) * G Did you materially participate' in the operation of this business during 2017? If 'No; see instructions for limit on losses M Yes 0 No H ff you started or acquired this business during 2017, check here I Did you make any payments in 2017 that would require you to file Form(s) 1099? (see instructions) 0 Yes MI No J If 'Yes; did you or will you file required Forms 1099? 0 Yes ILI No Part I I Income 1 Gross receipts or sales. See instructions for line 1 and check the box it this income was reported to you on Form W-2 and the "Statutory employee' box on that form was checked 2 Returns and allowances 3 Subtract line 2 from line 1 4 Cost of goods sold (from line 42) 5 Gross profit. Subtract line 4 from line 3 6 Other income, including federal and state gasoline or fuel tax credit or refund (see instructions) 7 Gross income. Add lines 5 and 6 Part 11 I Expenses. Enter expenses for business use ofyour home only on line 30. 8 9 10 11 12 13 14 15 16 17 28 Total expenses before expenses for business use of home. Add tines 8 through 27a ► 29 Tentative profit or (loss). Subtract line 28 from line 7 30 Expenses for business use of your home. Do no report these expenses elsewhere. Attach Form 8829 unless using the simplified method (see instructions). Simplified method filers only: enter the total square footage of: (a) your home: and (b) the part of your home used for business: Use the Simplified Method Worksheet in the instructions to figure the amount to enter on line 30 31 Net profit or (loss). Subtract line 30 from line 29. • If a profd, enter on both Form 1040, line 12 (or Form 1040NR, line 13) and on Schedule SE, line 2. (If you checked the box on line 1, see instructions). Estates and trusts, enter on Form 1041, line 3. • if a loss, you must go to line 32. 32 If you have a loss, check the box that describes your investment in this activity (see instructions). • If you checked 32a, enter the loss on both Form 1040, line 12, (or Form 1040NR, line 13) and on Schedule SE, line 2. (If you checked the box on line 1, see the line 31 instructions). Estates and trusts, enter on Form 1041, line 3. • If you checked 32b. you mustattach Form 6198. Your loss may be limited. LtiA For Paperwork Reduction Act Notice, see the separate instructions. 1 2 3 4 5 6 7 3,230,000. 3,230,000. 1,510,000. 1,720,000. 1,720,000. Advertising 8 4,850. 18 Office expense Car and truck expenses 19 Pension and profit-sharing plans (see instructions) 9 20 Rent or lease (see instructions): Commissions and fees 10 a Vehicles, machinery, and equipment Contract labor (see instructions) , Depletion 11 b 21 Other business property Repairs and maintenance 12 Depreciation and section 179 22 Supplies (not included in Part Ill) expense deduction (not included in 23 Taxes and licenses Part Ill) (see instructions) 13 24 Travel, meals, and entertainment Employee benefit programs (other a Travel than on line 19) 14 b Deductible meals and Insurance (other than health) 15 1,159. entertainment (see instructions) Interest: 25 Utilities a Mortgage (paid to banks, etc.) 16a 26 Wages (less employment credits) b Other 16b 27 a Other expenses (from tine 48) Legal and professional services 17 12,000. b Reserved for future use 18 19 20a 20b 21 22 23 78,480. 24a 24b 25 26 27a 27b 28 29 48,958. 1,686. 147,133. 1,572,867. 30 31 1,572,867. 32a ais at .1* 32b 0 is:nmeo, alinves iigir°nt Schedule C (Form 1040)2017 720001 10.21-17 EFTA00792020
Schedule C (Form 1040)2017 ANASTASIYA SIROOCHENKO Part Ill I Cost of Goods Sold (see instructions) 33 Method(s) used to value closing inventory: a K Cost b Lower of cost or market ***-**-9816 Paget c Other (attach explanation) 34 Was there any change in determining quantities, costs, or valuations between opening and closing inventory? If Yes:attach explanation Yes No 35 Inventory at beginning of year. If different from last years closing inventory, attach explanation 36 Purchases less cost of items withdrawn for personal use 37 Cost of labor. Do not include any amounts paid to yourself 38 Materials and supplies 39 Other costs $EE STATEMENT 10 40 Add lines 35 through 39 41 Inventory at end of year 35 36 1,285,000. 37 38 39 225,000. 40 1,510,000. 41 42 Cost of goods sold. Subtract line 41 from line 40. Enter the result here and on line 4 "j" 42 1,510,000. Part IV Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9 and are not required to file Form 4562 for this business. See the instructions for line 13 to find out if you must file Form 4562. 43 44 When did you place your vehicle in service for business purposes? (month, day, year) ► / Of the total number of miles you drove your vehicle during 2017, enter the number of miles you used your vehicle for: a Business b Commuting c Other 45 Was your vehicle available for personal use during off-duty hours? EI Yes No 46 Do you (or your spouse) have another vehicle available for personal use? EI Yes No 47 a Do you have evidence to support your deduction? Yes No b If Yes:' is the evidence written? Yes No Part V I Other Expenses. List below business expenses not included on lines 8-26 or line 30. PAYROLL PROCESSING FEES EXHIBITIONS FILING FEE 801. 860. 25. 48 Total other expenses. Enter here and on line 27a 48 1,686. 720002 10-21.17 S hedule C (Form t040) 2017 EFTA00792021
SCHEDULE SE (Form 1040) Departmoni of 174 Tieasuy internal Revolt* Service (99 Self-Employment Tax 0 Go to wvny.irs.gov/ScheduleSE for instructions and the latest Information. 0 Attach to Form 1040 or Form 1040NR. Name of person with self-employment income (as shown on Form 1040 or Form 1040NR) ANASTASIYA SIROOCHENKO Before you begin: To determine if you must file Schedule SE. see the instructions. Social security number of person with self-employment income ► OMB No 1545.0074 2017 Anaa01401 Sa4.70140 NO 11 ***4** 9816 May I Use Short Schedule SE or Must I Use Long Schedule SE? Note: Use this flowchart only If you must file Schedule SE. If unsure, see Who Must File Schedule SEin the instructions. Did you receive wages or tips In 2017? No 4 Are you a minister, member of a religious order, or Christian Science practitioner who received IRS approval notto be taxed on earnings from these sources, but you owe self-employment tax on other earnings? I F No Are you using one of the optional methods to figure your net earnings (see instructions)? No Did you receive church employee i come (see instructions) reported on Form W-2 of $10828 r more? j, No You may use Short Schedule SE below Yes Yes No Yes Was the total of your wages nd tips subject to social security or railroad retirement (tier 1) lax plus your net earnings from self-employment more than $127,200? Yes 10 Yes, No Did you receive tips subject to social security or Medicare tax that you didn't report to our employer? Yes Yes t No Did you report any wages o Form 8919, Uncollected Social Security and Medicare Tax o Wages? -11 • You must use Long Schedule SE on page 2 Section A-Short Schedule SE. Caution: Read above to see if you can use Short Schedule SE. la Net farm profit or (loss) from Schedule F, line 34, and farm partnerships, Schedule (Form 1065), box 14, code A b If you received social security retirement or disability benefits, enter the amount of Conservation Reserve Program payments included on Schedule F. line 4b. or listed on Schedule K-1 (Form 1065), box 20. code Z 2 Net profit or (loss) from Schedule C. line 31: Schedule C.EZ. line 3: Schedule K-1 (Form 1065), box 14, code A (other than farming); and Schedule K.1 (Form 1065-B). box 9. code J1. Ministers and members of religious orders. see instructions for types of income to report on this line. See instructions for other income to report STMT 11 3 Combine lines la, 1 b, and 2 4 Multiply line 3 by 92.35% (0.9235). If less than $400, you dont owe selfemployment tax;don't file this schedule unless you have an amount on Nne 1 b ► Note: If line 4 is less than $400 due to Conservation Reserve Program payments on line lb, see instructions 5 Self-employment tax. If the amount on Me 4 is: • $127.200 or less, multiply line 4 by 15.3% (0.153). Enter the result here and on Form 1040, line 57, or Form 1040NR, line 55 • More than $127200. multiply line 4 by 2.9% (0.029). Then, add $15,772.80 to the result. Enter the total here and on Form 1040, line 57, or Form 1040NR, line 55 6 Deduction for one-half of self-employment tax. line 5 by 50% (0.50). Enter the result here and on Mu Form 1040 line 27, or Form 1040NR line 27 6 28,949. ltiply LHA For Paperwork Reduction Act Notice, see your tax return instructions. la lb 2 3 1,572,867. 1,572,867. 4 1,452,543. 5 57,897. Schedule SE (Form 1040) 2017 724501 ID-20.17 EFTA00792022
DOES NOT APPLY Form 6251 Dope/Iman1I31 trio riaawy inwnit/ RO,N,IW SorvIco (911) Alternative Minimum Tax - Individuals 10. Go to vnvw.irs.gov/Form6251 for instructions and the latest information. ► Attach to Form 1040 or Form 1040NR. Name(s) shown on Form 1040 or Form 1040NR ANASTASIYA SIROOCHENKO OMR No 1545.0374 2017 AttacNnont SOCHAnco No. 32 Your social security number ***_**_9816 Part I I Alternative Minimum Taxable Income 1 If filing Schedule A (Form 1040), enter the amount from Fomi 1040. line 41. and go to line 2. Otherwise, enter the amount from Form 1040, line 38, and go to line 7. (If less than zero. enter as a negative amount.) 2 Reserved for future use 3 Taxes from Schedule A (Form 1040). line 9 4 Enter the home mortgage interest adjustment. if any, from line 6 of the worksheet In the instructions for this line 5 Miscellaneous deductions from Schedule A (Form 1040), line 27 6 If Form 1040, line 38, is $156,900 or less, enter •0•. Otherwise, see instructions 7 Tax refund from Form 1040. line 10 or line 21 8 Investment interest expense (difference between regular tax and AMT) 9 Depletion (difference between regular tax and AMT) 10 Net operating loss deduction from Form 1040, line 21. Enter as a positive amount 11 Alternative tax net operating loss deduction 12 Interest from specified private activity bonds exempt from the regular tax 13 Qualified small business stock, see instructions 14 Exercise of incentive stock options (excess of AMT income over regular tax income) 15 Estates and trusts (amount from Schedule K•1 (Form 1041), box 12, code A) 16 Electing large partnerships (amount from Schedule K•1 (Form 10658). box 6) 17 Disposition of property (difference between AMT and regular tax gain or loss) 18 Depreciation on assets placed in service after 1986 (difference between regular tax and AMT) 19 Passive activities (difference between AMT and regular tax income or loss) 20 Loss limitations (difference between Ma and regular tax income or loss) 21 Circulation costs (difference between regular tax and AMT) 22 Longterm contracts (difference between AMT and regular tax income) 23 Mining costs (difference between regular tax and AMT) 24 Research and experimental costs (difference between regular tax and MIT) 25 Income from certain installment sales before January 1. 1987 26 Intangible drilling costs preference 27 Other adjustments, including incomebased related adjustments 28 Alternative minimum taxable Income. Combine lines 1 through 27. (If married fling separately and line 28 is more than $249,450. see instructions.) 1 1,342,576. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 214,641. -38,380. 28 1,518,837. part it I Alternative Minimum Tax (AMT) 29 Exemption. (If you were under age 24 at the end of 2017. see instructions.) IF your filing status is... AND line 28 is not over... THEN enter on line 29... Single or head of household $120.700 $54,300 Married filing jointly or qualifying wiclow(er) 160,900 84,500 Married filing separately 80,450 42,250 If line 28 is over the amount shown above for your filing status. see instructions 30 Subtract line 29 from lino 28.1t mare Man mid. go id line 31. 11 pato 04 lea. enter hofo owl on linos 31.33. and 35. and do to lino 34 31 • If you are filing Form 2555 or 2555-EZ. see instructions for the amount to enter. • If you reported capital gain distributions directly on Form 1040, line 13; you reported qualified dividends on Form 1040. line 9b; or you had a gain on both lines 15 and 16 of Schedule D (Form 1040) (as refigured for the AMT, if necessary), complete Part III on page 2 and enter the amount from line 64 here. • All others: If line 30 is $187,800 or less ($93,900 or less if married filing separately), multiply line 30 by 26% (0.26). Otherwise, multiply line 30 by 28% (0.28) and subtract $3.756 ($1.878 if married filing separately) from the result. Alternative minimum tax foreign tax credit (see instructions) Tentative minimum tax. Subtract line 32 from line 31 32 33 34 Add Form 1040. line 44 (minus any tax from Form 4972), and Form 1040, line 46. Subtract from the result any foreign tax credit from Form 1040, line 48. If you used Sch J to figure your tax on Form 1040, line 44, refigure that tax without using Schedule J before completing this line (see instructions) 35 AMT. Subtract line 34 from line 33. If zero or less, enter 4. Enter here and on Form 1040. fine 45 29 0. 30 1,518,837. 31 421,518. 32 33 421,518. 34 35 487,479. 0. 7194151 01-11.15 LHA For Paperwork Reduction Act Notice, see your tax return Instructions. Form 6251 (2017) EFTA00792023
Form 6251 (2017) ANASTASIYA SIROOCHENKO Part Tax Computation Using Maximum Capital Gains Rates Complete Part III only if you are required to do so by line 31 or by the Foreign Earned Income Tax Worksheet in the instructions. ***-**-9816 Page 2 36 Enter the amount from Form 6251, line 30. If you are filing Form 2555 or 2555•EZ, enter the amount from line 3 of the worksheet in the instructions for line 31 37 Enter the amount from line 6 of the Qualified Dividends and Capital Gain Tax Worksheet in the instructions for Form 1040. line 44, or the amount from line 13 of the Schedule D Tax Worksheet in the instructions for Schedule D (Form 1040), whichever applies (as refigured for the AMT, if necessary) (see instructions). If you are filing Form 2555 or 2555•EZ, see instructions for the amount to enter 38 Enter the amount from Schedule D (Form 1040), line 19 (as refigured for the AMT, if necessary) (see instructions). If you are filing Form 2555 or 2555•EZ, see instructions for the amount to enter 39 If you did not complete a Schedule D Tax Worksheet for the regular tax or the AMT. enter the amount from Me 37. Otherwise, add lines 37 and 38, and enter the smaller of that result or the amount from line 10 of the Schedule D Tax Worksheet (as refigured for the AMT, if necessary). If you are filing Form 2555 or 255.5•EZ. see instructions for the amount to enter 40 Enter the smaller of line 36 or Me 39 41 Subtract line 40 from line 36 42 If line 41 is $187,800 or less ($93,900 or less if married filing separately), multiply line 41 by 26% (0.26). Otherwise. multiply line 41 by 28% (0.28) and subtract $3.756 ($1.878 if married filing separately) from the result ► 43 Enter: • $75.900 if maMed filing jointly or qualifying widow(er). • $37.950 if single or married filing separately, or • $50.800 if head of household. 44 Enter the amount from line 7 of the Qualified Dividends and Capital Gain Tax Worksheet in the instructions for Form 1040, line 44, or the amount from line 14 of the Schedule D Tax Worksheet in the instructions for Schedule D (Form 1040), whichever applies (as figured for the regular tax). If you did not complete either worksheet for the regular tax, enter the amount from Form 1040, line 43; If rigor lessonter O. If you are filing Form 2555 or 255.5•EZ, see instructions for the amount to enter 45 Subtract line 44 from line 43. If zero or less, enter 0. 46 Enter the smaller of line 36 or line 37 47 Enter the smaller of line 45 or line 46. This amount is taxed 0% 48 Subtract Me 47 from line 46 49 Enter: • $418,400 if single • $235,350 if maMed filing separately • $470,700 if maMed filing jointly or qualifying widow(er) • $444,550 if head of household 60 Enter the amount from line 45 61 Enter the amount from line 7 of the Qualified Dividends and Capital Gain Tax Worksheet in the instructions for Form 1040. line 44. or the amount from line 19 of the Schedule D Tax Worksheet, whichever applies (as figured for the regular tax). If you did not complete either worksheet for the regular tax, enter the amount from Form 1040, line 43: if zero or less, enter <I-. If you are filing Form 2555 or Form 2555•EZ, see instructions for the amount to enter 52 Add line 50 and line 51 53 Subtract line 52 from line 49. If zero or less, enter 41 54 Enter the smaller of line 48 or line 53 55 Multiply line 54 by 15% (0.15) ► 58 Add lines 47 and 54 If lines 56 and 36 are the same, skip lines 67 through 61 and go to line 62. Otherwise, go to line 67. 57 Subtract line 56 from line 46 58 Multiply line 57 by 20% (0.20) ► If line 38 is zero or blank, skip lines 69 through 61 and go to line 62. Otherwise, go to line 69. 59 Add lines 41, 56, and 57 60 Subtract line 59 from line 36 61 Multiply line 60 by 25% (0.25) ► 62 Add Fries 42. 55, 58, and 61 63 If line 36 is $187,800 or less ($93,900 or less if married filing separately). multiply line 36 by 26% (0.26). Otherwise, multiply line 36 by 28% (0.28) and subtract $3.756 ($1.878 if married filing separately) from the result 64 Enter the smaller of line 62 or line 63 here and on line 31. If you are filing Form 2555 or 2555EZ, do not enter this amount on line 31. Instead. enter it on line 4 of the worksheet in the instructions for line 31 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 719591 01-11.15 Form 6251 '201 /s EFTA00792024
Form 8959 Ova/1MM of taw Inman Infernal Revenue Sento Additional Medicare Tax ► If any line does not apply to you, leave it blank. See separate instructions. ► Attach to Form 1040, 1040NR, 1040-PR, or 1040-SS. ► Go to www.irs.gov/Form8959 for instructions and the latest information. cue No, I545.0074 2017 Anatimeni $Nauena NO. 71 Name(s) shown on return ANA S TAS I YA S I ROOCHENKO Part I Additional Medicare Tax on Medicare Wa g es Your social security number ***-**-9816 1 Medicare wages and tips from Form W2. box 5. If you have more than one Form W-2, enter the total of the amounts from box 5 1 2 Unreported tips from Form 4137, line 6 2 3 Wages from Form 8919, line 6 3 4 Add lines 1 through 3 4 6 Enter the following amount for your filing status: Married filing jointly $250,000 Married filing separately $125,000 Single, Head of household, or Qualifying wldow(er) $200,000 5 6 Subtract line 5 from line 4. If zero or less. enter O- 6 7 Additional Medicare Tax on Medicare wages. Multiply line 6 by 0.9% (0.009). Enter here and go to Part II I 7 Part II Additional Medicare Tax on Self-Employment Income 8 Self-employment income from Schedule SE (Form 1040), Section A, line 4, or Section B, line 6. If you had a loss, enter 0- (Form 1040•PR and Form 1040.59 filers, see instructions.) 8 1,452,543. 9 Enter the following amount for your filing status: Married filing jointly $250,000 Married filing separately $125,000 Single. Head of household, or Qualifying widow(er) $200,000 9 200,000. 10 Enter the amount from line 4 10 11 Subtract line 10 from line 9. If zero or less. enter .0- 11 200,000. 12 Subtract line 11 from line 8. If zero or less, enter .0. 12 1,252,543. 13 Additional Medicare Tax on self-employment income. Multiply line 12 by 0.9% (0.009). Ente here and go to Part III 13 11,273. Part III Additional Medicare Tax on Railroad Retirement Tax Act (RRTA) Compensation 14 Railroad retirement (ARTA) compensation and tips from Form(s) W2, box 14 (see instructions) 14 15 Enter the following amount for your filing status: Married filing jointly $250,000 Married filing separately $125,000 Single, Head of household, or Qualifying widow(er) $200,000 16 16 Subtract line 15 from line 14. If zero or less, enter O- 17 Additional Medicare Tax on railroad retirement (RATA) compensation. Multiply line 16 by 16 0.9% (0.009). Enter here and go to Part IV 17 Part IV Total Additional Medicare Tax 18 Add lines 7. 13. and 17. Also include this amount on Form 1040. line 62. (Form 1040NR. 1040 PR. and 1040SS filers. see instructions) and go to Part V 18 11,273. Part V Withholding Reconciliation 19 Medicare tax withheld from Form W-2, box 6. If you have more than one Form W2. enter the total of the amounts from box 6 20 Enter the amount from line 1 21 Multiply line 20 by 1.45% (0.0145). This is your regular Medicare tax withholding on Medicare wages 22 Subtract line 21 from line 19. If zero or less, enter This is yourAdditional Medicare Tax withholding on Medicare wages 23 Additional Medicare Tax withholding on railroad retirement (RRTA) compensation from Form W-2, box 14 (see instructions) 24 Total Additional Medicare Tax withholding. Add lines 22 and 23. Also Include this amount with federal income tax withholding on Form 1040, line 64 (Fern) 1040NR. 1040-PR. and 1040SS filers, see instructions) 19 20 21 22 23 24 773111 12-13-17 LHA For Paperwork Reduction Act Notice, an your tax return Instructions. Form 8959 (2017) EFTA00792025
For. 8960 Department of tho Treasury internal Raven.. Novice (90) Name(s) shown on your tax return ANASTASIYA SIROOCHENKO Part I Investment Income U Section 6013(g) election (see instructions) Section 6013(h) election (see instructions) Regulations section 1.1411.10(g) election (see instructions) Net Investment Income Tax - Individuals, Estates, and Trusts ► Attach to your tax return. IP. Go to www.Irs.goviform8960 for instructions and the latest information orke NO. 1545.2227 2017 ANN :Omani Sequence No. 72 Your social 'loudly number or EIN ***-**-9816 1 Taxable interest (see instructions) 2 Ordinary dividends (see instructions) 3 Annuities (see instructions) 4a Rental real estate, royalties, partnerships, S corporations, trusts, etc. (see instructions) b Adjustment for net income or loss derived in the ordinary course of a non•section 1411 trade or business (see instructions) c Combine Ines 4a and 4b 6a Net gain or loss from disposition of property (see instructions) b Net gain or loss from disposition of property that is not subject to net investment income tax (see instructions) c Adjustment from disposition of partnership interest or S corporation 4 stock (see instructions) 1 2 3 755. 4c d Combine Ines 5a through 5c 6 Adjustments to investment income for certain CFCs and PFICs (see instructions) 7 Other modifications to investment income (see instructions) 8 Total investment income. Combine lines 1.2,3.4c. 5d. 6. and 7 Part II Investment Expenses Allocable to Investment Income and Modifications 9a Investment interest expenses (see instructions) b State, local, and foreign income tax (see instructions) c Miscellaneous investment expenses (see instructions) d Add lines 9a. 9b, and 9c 10 Additional modifications (see instructions) 11 Total deductions and modifications. Add lines 9d and 10 . Part III Tax Computation 12 Net investment income. Subtract Part II. line 11 from Part I, line 8. Individuals complete lines 13- 17. Estates and trusts complete lines 18a21. If zero or less, enter Individuals: 13 Modified adjusted gross income (see instructions) 13 1,540,837. 14 Threshold based on filing status (see instructions) 14 15 Subtract line 14 from line 13. If zero or less, enter .0. 15 16 Enter the smaller of line 12 or line 15 17 Net investment income tax for individuals. Multiply line 16 by 3.8% (.038).Enter here and Include on your tax return (see instructions) Estates and Trusts: 18a Net investment income (line 12 above) 18a b Deductions for distributions of net investment income and deductions under section 642(c) (see instructions) c Undistributed net investment income. Subtract line 18b from 18a (see instructions). If zero or less, enter Cl• 19a Adjusted gross income (see instructions) b Highest tax bracket for estates and trusts for the year (see instructions) c Subtract line 19b from line 19a. If zero or less, enter .0- 20 Enter the smaller of line 18c or line 19c 200,000. 1,340,837. 5d 6 7 8 755. 9a 913. 9c 170. 18b 18c 19a 19b 19c 21 Net investment income tax for estates and trusts. Multiply line 20 by 3.8% (.038). Enter here and Include on your tax return (see instructions) LHA For Paperwork Reduction Act Notice, see your tax return instructions. Form 8960 (2017) 9d 10 11 170. 12 170. 585. 16 585. 17 22. 20 21 723121 12-22-1T EFTA00792026
Lines 9 and 10 - Application of Itemized Deduction Limitations on Deductions Properly Allocable to Investment Income Worksheet Part I - Application of Section 67 to Deductions Properly Allocable to Investment Income 1. Enter the amount of Miscellaneous Itemized Deductions properly allocable to investment income before any itemized deduction limitations (Description and Form 8960 line number where they'll be reported): Description Line Amount (a) (b) 2. Enter the total of all items listed in line 1 2. 3. Enter the amount of all Miscellaneous Itemized Deductions after the application of the section 67 limitation (Schedule A (Form 1040), line 27) 3. 4. Enter the lesser of the total reported on line 2 or line 3 4. Part II - Application of Section 67 Limitation to Specific Deductions (B) IF line 3 is less than line 2. THEN divide . line 3 by line 2 AND P H enter the amount in column (B). IF amounts reported (C) Multiply the 4 are equal, THEN in column (A) by the (A) li t!P ilit' on Part I. lines 2 and individual amoums enter 1.00 in column amount in column Reenter the amounts and descriptions from Part I, line 1. B (B). Description Line Amount (a) X = (b) X = i Individuals - Use the amounts in column (C) on Part Ill, line I, to determine the amount of these deductions that are TI P allowable after the application of the section 68 limitation. Estates or trusts - Enter the amounts in column (C) in the appropriate location on lines 9 and 10. Don't complete Parts III or IV of this worksheet. Keep for Your Records 123351 01-10-18 EFTA00792027
Lines 9 and 10 - Application of Itemized Deduction Limitations on Deductions Properly Allocable to Investment Income Worksheet - continued Keep for Your Records Part III - Application of Section 68 to deductions properly allocable to investment income (Individuals Only) 1. Enter the amount of Miscellaneous Itemized Deductions properly allocable to investment income from column (C) of Part II: Description Line Amount (a) (b) 2. Enter the amount of state, local, and foreign Income taxes that are properly allocable to investment income 2. 170. 3. Enter the amounts of other Itemized Deductions subject to the section 68 limitation and properly allocable to investment income before any itemized deduction limitations (Description and Form 8960 line number where they'll be reported): Description Line Amount (a) (b) 4. Enter the total deductions properly allocable to investment income subject to the section 68 limitation. Enter the sum of lines 1 through 3 4. 5. Enter the amount of total itemized deductions reported on Form 1040 5. 198,261. 6. Enter all other itemized deductions allowed but not subject to the section 68 deduction limitation: (a) Investment Interest Expense (b) Casualty Losses (other than losses described in section 16.5(cX1)) (c) Medical Expenses (d) Gambling Losses (e) Total of lines 6(a) through 6(d) 8e. 7. Subtract line 6e from Me 5 7. 198,261. & Enter the lesser of line 7 or line 4 8. 170. 170. TIP This is the amount of itemized deductions that are properly allocable to investment income after the application of the sections 67 and 68 deduction limitations. Use Part IV of this worksheet to reconcile this amount to the Individual deduction amounts reported on Form 8960, lines 9 and 10. Part IV - Reconciliation of Schedule A Deductions to Form 8960, lines 9 and 10 (Individuals Only) (A) Reenter the amounts and descriptions from Part III, lines 1 3. Miscellaneous Itemized Deductions properly allocable to investment Income: Description, Line Amount 1. (a) (b) 2. State, local, and foreign income taxes Itemized Deductions Subject to Section 68 included on Line 3 of Part III: 3. (a) (b) X X (B) IF Part III, line 8 is less than Part III. line 4. THEN divide line 8 by line 4 AND enter the amount in column (B). IF the amounts reported on Part III, lines 4 and 8 are equal. THEN enter 1.00 in column (Ell. 170. x 1.0000 X X (C) Multiply the individual amounts in column (A) by the amount in column (B). Enter these amounts in the appropriate location on lines 9 and 10. 70. 72325201-10.M EFTA00792028
Form 8960 Net Investment Income Tax - Individuals, Estates, and Trusts 2017 NEW YORK Name(s) Your social security number or EIN ANASTASIYA SIROOCHENKO ***_**_9816 Part I Investment Income U section 6013(g) election Regulations section 1.1411.10(g) election 1 Taxable interest (Form 1040, line 8a: or Form 1041, line 1) 2 Ordinary dividends (Form 1040. line 9a: or Form 1041, line 2a) 3 Annuities from nongualified plans 4a Rental real estate, royalties, partnerships, S corporations, trusts, etc. (Form 1040, line 17: or Form 1041, line 5) b Adjustment for net income or loss derived in the ordinary course of a non•section 1411 trade or business c Combine lines 4a and 4b 0. 1 2 3 755. 0. 6a Net gain or loss from disposition of property from Form 1040, combine lines 13 and 14; or from Form 1041. combine lines 4 and 7 b Net gain or loss from disposition of property that is not subject to net investment income tax c Adjustment from disposition of partnership interest or S corporation stock d Combine lines 5a through 5c 6 Changes in investment income for certain CFCs and PFICs 7 Other modifications to investment income 8 Total investment income. Combine lines 1. 2. 3. 4c. 5d. 6. and 7 / Part II State Income Tax Pro-ration for 2017 Income Tax Payments 9 State total income 10 State income tax payments for 2017 11 2017 state income tax payments attributable to investment income. line 8 divided by line 9 times line 10 Part III State Income Tax Pro-ration for 2016 Estimate Payments Made in 2017 12 State estimate payments for 2016 13 Percent of state income taxes attributable to investment income for 2016 14 2016 state estimate payments attributable to investment income. Line 12 times line 13 Part IV State Income Tax Pro-ration for Balance of Prior Years Tax Plus Extension Pa 4c 0. 0. 5d 6 7 8 0. 755. y 9 10 11 1,610,837. 205,000. 12 13 14 96. ments Paid in 2017 15 Balance of prior years tax plus extension payments paid in 2017 15 9,641. 16 Percent of state income taxes attributable to investment income for 2016 16 .007631 17 Balance of prior years tax and extension payments attributable to investment income. Line 15 times line 16 17 74. Part V Reduction of State Tax Deduction 18 Reduction of state tax deduction 18 19 Percent of state income taxes attributable to investment income for 2016 19 20 Reduction of state tax deduction attributable to investment income. Line 18 times line 19 20 Part VI Total State Income Tax Payments Attributable to Investment Income 21 Combine lines 11. 14. 17 and 20. Carry to Form 8960. Line 9 Worksheet. Part III. line 2 21 170. Form 8960 (2017) 723161 04.OIn7 EFTA00792029
ANASTASIYA SIROOCHENKO ***-**-9816 FORM 1040 PERSONAL EXEMPTION WORKSHEET STATEMENT 1 1. IS THE AMOUNT ON FORM 1040, LINE 38, MORE THAN THE AMOUNT SHOWN ON LINE 4 BELOW FOR YOUR FILING STATUS? NO. STOP. MULTIPLY $4,050 BY THE TOTAL NUMBER OF EXEMPTIONS CLAIMED ON FORM 1040, LINE 6D, AND ENTER THE RESULT ON LINE 42. YES. CONTINUE 2. MULTIPLY $4,050 BY THE TOTAL NUMBER OF EXEMPTIONS CLAIMED ON FORM 1040, LINE 6D 4,050. 3. ENTER THE AMOUNT FROM FORM 1040, LINE 38 1,540,837. 4. ENTER THE AMOUNT FOR YOUR FILING STATUS 261,500. SINGLE $261,500 MARRIED FILING JOINTLY OR WIDOW(ER) $313,800 MARRIED FILING SEPARATELY $156,900 HEAD OF HOUSEHOLD $287,650 5. SUBTRACT LINE 4 FROM LINE 3. IF THE RESULT IS MORE THAN $122,500 ($61,250 IF MARRIED FILING SEPARATELY), STOP. ENTER -0- ON LINE 42 1,279,337. 6. DIVIDE LINE 5 BY $2,500 ($1,250 IF MARRIED FILING SEPARATELY). IF THE RESULT IS NOT A WHOLE NUMBER, INCREASE IT TO THE NEXT HIGHER WHOLE NUMBER (FOR EXAMPLE, INCREASE 0.0004 TO 1) 7. MULTIPLY LINE 6 BY 2% (.02) AND ENTER THE RESULT AS A DECIMAL 8. MULTIPLY LINE 2 BY LINE 7 9. SUBTRACT LINE 8 FROM LINE 2. TOTAL TO FORM 1040, LINE 42. STATEMENT(S) 1 EFTA00792030
ANASTASIYA SIROOCHENKO ***-**-9816 FORM 1040 SELF-EMPLOYED HEALTH INSURANCE DEDUCTION WORKSHEET STATEMENT 2 ANASTASIYA SIROOCHENKO SUBLIME ART LLC 1 NONSPECIFIED HEALTH INSURANCE PAYMENTS 3,836. 2 NET PROFIT FROM TRADE OR BUSINESS UNDER WHICH INSURANCE PLAN IS ESTABLISHED 1,572,867. 3 TOTAL OF ALL NET PROFITS AND EARNED INCOME. S CORPORATIONS SKIP TO LINE 9 1,572,867. 4 DIVIDE LINE 2 BY LINE 3 1.0000 5 DEDUCTIBLE PORTION OF SELF-EMPLOYMENT TAX 28,949. 6 LINE 4 TIMES LINE 5 28,949. 7 LINE 2 MINUS LINE 6 1,543,918. 8 SELF-EMPLOYED SEP, SIMPLE, AND QUALIFIED PLANS ATTRIBUTABLE TO TRADE OR BUSINESS NAMED ABOVE 0. 9 LINE 7 MINUS LINE 8. S CORPORATIONS ENTER WAGES RECEIVED 1,543,918. 10 FORM 2555, LINE 45 ATTRIBUTABLE TO THE TRADE OR BUSINESS NAMED ABOVE 11 LINE 9 MINUS LINE 10 1,543,918. 12 SELF-EMPLOYED HEALTH INSURANCE DEDUCTION. LESSER OF LINE 1 OR LINE 11 3,836. FORM 1040 OTHER TAXES STATEMENT 3 DESCRIPTION AMOUNT FROM FORM 8959 11,273. FROM FORM 8960 22. TOTAL TO FORM 1040, LINE 62 11,295. STATEMENT(S) 2, 3 EFTA00792031
ANASTASIYA SIROOCHENKO ***-**-9816 FORM 1040 TOTAL DUE WITH INTEREST AND PENALTIES STATEMENT 4 AMOUNT DUE 9,671. INTEREST NOT INCLUDED 245. TOTAL DUE 9,916. FORM 1040 LATE PAYMENT INTEREST STATEMENT 5 DESCRIPTION TAX DUE FORM 4868 PAYMENT DATE FILED DATE AMOUNT BALANCE RATE DAYS INTEREST 04/15/18 04/15/18 10/15/18 509,671. -500,000. 509,671. .0500 9,671. .0500 183 245. 9,916. TOTAL LATE PAYMENT INTEREST 245. FORM 1040 CURRENT YEAR ESTIMATES AND STATEMENT 6 AMOUNT APPLIED FROM PREVIOUS YEAR DESCRIPTION AMOUNT 4TH QTR ESTIMATE PAYMENT 47,000. TOTAL TO FORM 1040, LINE 65 47,000. SCHEDULE A STATE AND LOCAL INCOME TAXES STATEMENT 7 DESCRIPTION AMOUNT NEW YORK 4TH QTR ESTIMATE PAYMENTS 205,000. NEW YORK PRIOR YEAR BALANCE DUE AND EXTENSION PAYMENTS 9,641. TOTAL TO SCHEDULE A, LINE 5 214,641. STATEMENT(S) 4, 5, 6, 7 EFTA00792032
ANASTASIYA SIROOCHENKO ***-**-9816 SCHEDULE A CASH CONTRIBUTIONS STATEMENT 8 DESCRIPTION AMOUNT AMOUNT AMOUNT 100% LIMIT 50% LIMIT 30% LIMIT BYRD HOFFMAN WATER MILL FOUNDATION 22,000. SUBTOTALS 22,000. TOTAL TO SCHEDULE A, LINE 16 22,000. STATEMENT(S) 8 EFTA00792033
ANASTASIYA SIROOCHENKO ***-**-9816 SCHEDULE A ITEMIZED DEDUCTIONS WORKSHEET STATEMENT 9 1. ENTER THE TOTAL OF THE AMOUNTS FROM SCHEDULE A, LINES 4, 9, 15, 19, 20, 27, AND 28. 2. ENTER THE TOTAL OF THE AMOUNTS FROM SCHEDULE A, LINES 4, 14, AND 20, PLUS ANY GAMBLING AND CASUALTY OR THEFT LOSSES INCLUDED ON LINE 28 AND ANY QUALIFIED CONTRIBUTIONS INCLUDED ON LINE 16. 3. IS THE AMOUNT ON LINE 2 LESS THAN THE AMOUNT ON LINE 1? IF NO, YOUR DEDUCTION IS NOT LIMITED. ENTER THE AMOUNT FROM LINE 1 ABOVE ON SCHEDULE A, LINE 29. IF YES, SUBTRACT LINE 2 FROM LINE 1. 4. MULTIPLY LINE 3 BY 80% (.80). 189,313. 5. ENTER THE AMOUNT FROM FORM 1040, LINE 38. 1,540,837. 6. ENTER $313,800 IF MARRIED FILING JOINTLY OR QUALIFYING WIDOW(ER); $287,650 IF HEAD OF HOUSEHOLD; $261,500 IF SINGLE; OR $156,900 IF MARRIED FILING SEPARATELY. 261,500. 7. IS THE AMOUNT ON LINE 6 LESS THAN THE AMOUNT ON LINE 5? IF NO, YOUR DEDUCTION IS NOT LIMITED. ENTER THE AMOUNT FROM LINE 1 ABOVE ON SCHEDULE A, LINE 29. IF YES, SUBTRACT LINE 6 FROM LINE 5. 1,279,337. 8. MULTIPLY LINE 7 BY 3% (.03). 38,380. 9. ENTER THE SMALLER OF LINE 4 OR LINE 8. 236,641. 0. 236,641. 38,380. 10. TOTAL ITEMIZED DEDUCTIONS. SUBTRACT LINE 9 FROM LINE 1. ENTER THE RESULT HERE AND ON SCHEDULE A, LINE 29. 198,261. SCHEDULE C OTHER COSTS OF GOODS SOLD STATEMENT 10 DESCRIPTION AMOUNT BROKERAGE COMMISSION ON FOREIGN SALE 225,000. TOTAL TO SCHEDULE C, LINE 39 225,000. STATEMENT(S) 9, 10 EFTA00792034
ANASTASIYA SIROOCHENKO ***_**_9816 SCHEDULE SE NON-FARM INCOME STATEMENT 11 DESCRIPTION AMOUNT ART DEALER 1,572,867. TOTAL TO SCHEDULE SE, LINE 2 1,572,867. O STATEMENT(S) 11 EFTA00792035
DAVID WEISS CPA, PLLC 183 MADISON AVE SUITE 803 NEW YORK, NY 10016-4403 (212) 695-5771 OCTOBER 10, 2018 ANASTASIYA SIROOCHENKO 288 WEST 4TH ST NEW YORK, NY 10014 DEAR ANASTASIYA: ENCLOSED ARE YOUR 2017 NEW YORK INCOME TAX RETURN AND 2018 ESTIMATED TAX VOUCHERS. THIS RETURN HAS QUALIFIED FOR ELECTRONIC FILING. AFTER YOU HAVE REVIEWED YOUR RETURN FOR COMPLETENESS AND ACCURACY, PLEASE SIGN, DATE AND RETURN FORM TR-579-IT TO OUR OFFICE BY MAIL, E-MAIL ([email protected]), OR FAX (212-695-5772). WE WILL THEN TRANSMIT YOUR RETURN ELECTRONICALLY TO THE NY TAX DEPT, AND NO FURTHER ACTION IS REQUIRED. DO NOT MAIL THE PAPER COPY OF THE RETURN TO THE NY TAX DEPT. RETURN FORM TR-579-IT TO US AS SOON AS POSSIBLE (BY OCTOBER 15, 2018). YOUR OVERPAYMENT IN THE AMOUNT OF $12,317 HAS BEEN APPLIED TO YOUR STATE DECLARATION OF ESTIMATED TAX. NO PAYMENT IS REQUIRED. NEW YORK ESTIMATED TAX VOUCHERS: SEPARATELY MAIL VOUCHERS 1 AND 2 OF THE DECLARATION OF ESTIMATED TAX AS SOON AS POSSIBLE. ENCLOSE YOUR CHECK FOR $60,000, PAYABLE TO NEW YORK STATE INCOME TAX. INCLUDE YOUR SOCIAL SECURITY NUMBER AND THE WORDS "2018 FORM IT-2105" ON YOUR CHECK. ADDITIONAL ESTIMATED TAX PAYMENTS WILL ALSO BE DUE. PAYMENTS SHOULD BE MAILED TO THE FOLLOWING ADDRESS ON OR BEFORE THE DATES INDICATED. MAIL TO - NYS ESTIMATED INCOME TAX PROCESSING CENTER III. BOX 4122 BINGHAMTON, NY 13902-4122 FOR YOUR REFERENCE WE HAVE LISTED ALL ESTIMATED TAX PAYMENTS AND THEIR ORIGINAL DUE DATES BELOW. EFTA00792036
VOUCHER NO. 1 BY 04/17/18 NO PAYMENT REQUIRED VOUCHER NO. 2 BY 06/15/18 $60,000 VOUCHER NO. 3 BY 09/17/18 NO PAYMENT REQUIRED VOUCHER NO. 4 BY 01/15/19 $135,000 YOUR COPY OF THE SUGGEST THAT YOU VERY TRULY YOURS, DAVID WEISS RETURN IS ENCLOSED FOR YOUR FILES. WE RETAIN THIS COPY INDEFINITELY. EFTA00792037
/I -NEW YORK STATE 2017th Department of Taxation and Finance New York State E-File Signature Authorization for Tax Year 2017 For Forms IT-201, IT-201-X, IT-203, IT-203-X, IT-214, NYC-208, and NYC-210 Electronic return originator (ERO): Do not mai this form to the Tax Department. Keep it for your records. Taxpayer's name: ANASTASIYA SIROOCHENKO Purpose Form TR579•IT must be completed to authorize an ERO to efile a personal income tax return and to transmit bank account information for the electronic funds withdrawal. General instructions Taxpayers must complete Part B before the ERO transmits the taxpayer's electronically filed Form IT•201, ResWent Income Tax Return, IT•201•X, Amended Resident Income Tax Return, IT-203, NomesWent and Part-Year Resident Income Tax Return, IT•203•X, Amended Nonresident and Part-Year Resident income Tax Return, 1T-214, Oak?) for Real Property Tax Credit, INNC•208, Claim for New York City Enhanced Real Property Tax Credit, or NYC210, Claim for New York City School Tax Credit. For returns filed jointly, both spouses must complete and sign Form TR579•IT. Spouse's name: Oointly filed return °my) 788351 12.29-17 EROs must complete Part C prior to transmitting electronically filed income tax returns (Forms 11%201, 11%2014(.17.203, IT•203.X. IT•214, NYC•208, and NY0210). Both the paid preparer and the ERO are required to sign Part C. However, if an individual performs as both the paid preparer and the ERO, he or she is only required to sign as the paid preparer. It is not necessary to include the ERO signature in this case. Please note that an alternative signature can be used as described in Publication 58. Information for Income Tax Return Preparers. Go to our website at www.tax.ny.gov to view this document. Do not mail Form TR-579-IT to the Tax Department. EROs must keep this form for three years and present it to the Tax Department upon request. This form is not required for electronically filed Form II370, Application for Automatic Six-Month Extension of Time to File for Individuals. See Form TR879.1•IT, New York State Taxpayer Authorization for Electronic Funds Withdrawal for Tax Year 2017 Form IT-370 and Tax Year 20%8 Form IT-2105. Part A - Tax return information Federal adjusted gross income (from applicable line) Refund 1 2 3 Amount you owe 4 Financial institution routing number 5 Financial institution account number 6 Account type: D Personal checking D Personal savings Business checking Business savings Si 1540837 0 1. 2. 3. 4. 5. Part B Declaration of taxpayer and authorizations for Forms IT-201, IT-201-X, IT-203, IT-203-X, IT-214, NYC-208, and NYC-210 Under penalty of perjury, I declare that I have examined the information on my 2017 New York State electronic personal income tax return, including any accompanying schedules, attachments, and statements, and certify that my electronic return is true, correct, and complete. The ERO has my consent to send my 2017 New York State electronic return to New York State through the Internal Revenue Service (IRS). In addition, by using a computer system and software to prepare and transmit my form electronically, I consent to the disclosure to New York State of all information pertaining to the transmission of my tax form electronically. I understand that by executing this Form TR-579-IT, I am authorizing the ERO to sign and file this return on my behalf and agree that the ERO's submission of my personal income tax return to the IRS. together with this authorization, will serve as the electronic signature for the return and any authorized payment transaction. If I am paying my New York State personal income taxes due by electronic funds withdrawal, I certify that the account holder has authorized the New York State Tax Department and its designated financial agents to initiate an electronic funds withdrawal from the financial institution account indicated on my 2017 electronic return, and authorized the financial institution to withdraw 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 prior to the payment date. Taxpayers signature: Date: Spouse's signature: (jointly Ned return only) Date: Part C Declaration of electronic return originator (ERO) and paid preparer Under penalty of perjury, I declare that the information contained in this 2017 New York State electronic personal income tax returns the information furnished to me by the taxpayer. If the taxpayer furnished me a completed paper 2017 New York State retum signed by a paid preparer, I declare that the information contained in the taxpayer's 2017 New York State electronic return is identical to that contained in the paper copy of the return. If I am the paid preparer, under penalty of perjury I declare that I have examined this 2017 New York State electronic personal income tax retum, and, to the best of my knowledge and belief, the return is true, correct, and complete. I have based this declaration on all information available to me. ERO's signature: Print name: Paid preparer's signature: DAVID WEISS Print name: DAVID WEISS Date: Date: TR-579-IT (12/17) 1019 EFTA00792038
75804t I 0.27-17 rEf -2105-1 2IJ Page 1 Estimated tax worksheet (see instructions) 1 Enter amount of New York adjusted Toss Income (NYAGOyou expect In 2015 2 Enter either your standard deduction or estimated itemized deduction 3 Subtract line 2 from line 1 4 Dependent exemptions (multiply $1,000 by number of dependents) 5 Estimated NYS taxable income (subtract line 4 from line 3) 6 NYS tax on line 5 amount (see instructions) 7 NYC resident tax on line 5 amount (see Instructions) 8 NYC household credit and NYC accumulation distribution credit 9 Subtract line 8 from line 7 10 NYC tax on ordinary income portion of lump-sum distribution 11 Add Ines 9 and 10 12 NYC unincorporated business tax credit 12a NYC general corporation tax credit 12b Add Ines 12 and 12a 13 Subtract line 12b from line 11 14 Enter household aedit nonresidents and part-year residents also enter child and dependent care credit and earned income credit me nerrocpprep 15 Subtract line 14 from line 6 (see instructions) 16 Other taxes (see Instructions) 17 Add lines 15 and 16 (in NYC column: add Mem 13 and 16) 18 Resident credit and other nonrefundable credits (see instructions) 19 Total estimated NYS and NYC income tax (New York State column: subtract line 18 from line 17; New York City column: enter amount from line 17) 20 Refundable credits (see instructions) 21 NYS/NYC estimated income tax (subtract line 20 (mm Nne 19) 22 Yonkers: (a) resident tax surcharge (multiply fine 21, New York State column, by 16.75% (1675)) (b) nonresident earnings tax (from Form Y-203) (c) total (add lines 22a and 22b) 23 Totals (New York State column, line 2 1:New York City column, line 21; Yonkers column, line 22c; Estimated MCTMT worksheet, line 5) 24 Multiply line 23 by 90% (.90)(66 2/3% (.6667) for farmers and fishermen) 25 Enter your 2017 tax (see instructions) 26 Enter the lesser of line 24 or 25. This is your required annual payment (see Penalty for underpayment of estimated ta4. 27 Estimate of income tax to be withheld, estimated income tax paid with Form IT-2663 and/or IT-2664, and estimated tax paid on your behalf by a partnership or corporation 28 Balance (subtract line 27 from line 26). If any amount on this line, columns A, B, a C, is $300 or more, or if any amount is shown in column D, fill out and file the payment voucher along with your payment If each amount on this line (columns A, B, and C only) is less than $300, no payment is required at this time. If you are applying an overpayment from 2017 to 2018, see How to complete the payment voucher Computation of Installments: If the first installment Is paid: April 17. 2018 June 15, 2018 September 17.2018 January 15.2019 A New York State 1. 2. 3. 4. 5. 6. B- New York City j C - Yonkers 7 8 9 10 11 12 12a 12b 13 14. 15. 16. 17. 18. 19. 20. 21. 22a. 22b. 22c. D - MCTMT 23 24 25 26 27 28 ADJ TO 110% 154780 51600 5440 OVERPAYMENT APPLIED 1019 ESTIMATE PAID TO DATE Enter In the appropriate spaces on the voucher (less any 2017 overpayment you are applying to this Installment): 25% (.25) of line 28 50% (.50) of line 28 75% (.75) of line 28 amount on line 28 12317 45000 15000 EFTA00792039
2018 amoumm ana Total payment in me coxes to me nom. 2018 IT-2105 on your payment. Make payable to Processinci Center. PQ Box 4122. Binghamton NY vimr me 158! Tour agrts or your J,N or re WS Income Tax. Mail voucher and payrnen 13902-4122. Enter your 2-character special condition code if applicable (see/ pull SSN or taxpayer lu number *****9816 taxpayers first name and middle initial ANASTASIYA taxpayer s last name SIROOCHENKO Mailing address (number and street or PC box; see instructions) Apartment number 288 WEST 4TH ST laity, village, or post otnce NEW YORK Stale NY ZIP code 10014 i axpayer s e-mail address 768042 10.27.17 Department of Taxation and Finance Tips for Estimated Tax Did you know? You can pay your estimated tax electronically on our website with a debit from your checking or savings account. Visit us on the Web at www.tax.ny.gov to pay your estimated tax electronically. For assistance. see Form IT-21054, Instructions for Form IT-2105, Estimated Tax Payment Voucher forIndNlduals. To help us match your New York State estimated tax account to your New York State income tax return. and to avoid a delay in processing your return, please note the following: • Social security number (SSN)Aaxpayer identification OD) number - Make sure that the entire SSN used on your vouchers agrees with the number on your social security card and the number used on your New York State income tax return. If you use a taxpayer ID number, this number must agree with the number used on your New York State income tax retum. Failure to do so may result in monies not being properly credited to your account. • Name • Make 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: city. province or state, and then country (all in the City, village, or post office box). Follow the country's practice for entering the postal code. Do not abbreviate the country name. • Married taxpayers - Each married taxpayer should establish a separate estimated tax account. If you and your spouse each maintain an estimated tax account and file a joint New York State income tax return, we will credit the balances of both accounts to your joint income tax return. • All filers must be sure to separately enter the amounts for New York State. New York City. Yonkers, and MCTMT: then enter the total n the Total payment box. Note: If there is no amount to be entered for one or more Ines, leave them blank. Do not staple or clip the check or money order to the voucher. Please detach any check stubs before mailing. Need help? Visit our website at www.tany.gov • get information and manage your taxes online • check for new online services and features Telephone assistance Automated income tax refund status: (518) 457-514,1116. Personal Income Tax Information Center. (518) 457.5181 To order forms and publications: (518) 457-5431 Text Telephone (TTY) Hotline (for persons with hearing and speech disabilities using a TTY): If you have access to a TTY, contact us at (518) 485-5082. If you do not own a TTY, check with independent living centers or community action programs to find out where machines are available for public use. Persons with disabilities: In compliance with the Americans with Disabilities Act. we will ensure that our lobbies, offices, meeting rooms, and other facilities are accessible to persons with disabilities. If you have questions about special accommodations for persons with disabilities, call the information center. NEW Department of Taxation and Finance YORK STATE Estimated Tax Payment Voucher for Individuals New York State • New York City • Yonkers • MCTMT Detach (cut) here Calendar-year flier due dates: April 17.2018; June 15, 2018; September 17, 2018; and January 16,2019. Enter applicable payer ID number and to: NYS Estimated Income Tax, str) New York Stale 0 00 New YQIk City 0 00 Yonkers 00 KICTIK 0 00 Total payment A 00 IT-2105 Estimated tax amounts STOP: Pay this electronically on our website 0601181019 *****9816 9 EFTA00792040
2018 768042 10.27.17 Department of Taxation and Finance Tips for Estimated Tax Did you know? You can pay your estimated tax electronically on our website with a debit from your checking or savings account. Visit us on the Web at www.tax.ny.gov to pay your estimated tax electronically. For assistance. see Form IT-21054, Instructions for Form IT-2105, Estimated Tax Payment Voucher forIndNlduals. To help us match your New York State estimated tax account to your New York State income tax return. and to avoid a delay in processing your return, please note the following: • Social security number (SSNytaxpayer Identification OD) number - Make sure that the entire SSN used on your vouchers agrees with the number on your social security card and the number used on your New York State income tax return. If you use a taxpayer ID number, this number must agree with the number used on your New York State income tax retum. Failure to do so may result in monies not being properly credited to your account. • Name - Make 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 retum. • Foreign addresses - Enter the information in the following order: city. province or state, and then country (all in the City, village, or post office box). Follow the country's practice for entering the postal code. Do not abbreviate the country name. • Married taxpayers - Each married taxpayer should establish a separate estimated tax account. If you and your spouse each maintain an estimated tax account and file a joint New York State income tax return, we will credit the balances of both accounts to your joint income tax retum. • All filers must be sure to separately enter the amounts for New York State, New York City. Yonkers, and MCTMT: then enter the total n the Total payment box. Note: If there is no amount to be entered for one or more Ines, leave them blank. Do not staple or clip the check or money order to the voucher. Please detach any check stubs before mailing. Need help? Visit our website at www.tany.gov • get information and manage your taxes online • check for new online services and features Telephone assistance Automated income tax refund status: (518) 457-51491%, -1, Personal Income Tax Information Center. (518) 457-5181 To order forms and publications: (518) 457-5431 Text Telephone (TTY) Hotline (for persons with heating and speech disabilities using a TTY): If you have access to a TTY, contact us at (518) 485-5082. If you do not own a TTY. check with independent living centers or community action programs to find out where machines are available for public use. Persons with disabilities: In compliance with the Americans with Disabilities Act. we will ensure that our lobbies, offices, meeting rooms, and other facilities are accessible to persons with disabilities. If you have questions about special accommodations for persons with disabilities, call the information center. NEW Department of Taxation and Finance YORK STATE Estimated Tax Payment Voucher for Individuals New York State • New York City • Yonkers • MCTMT 41 Detach (cut) here Calendar-year flier due dates: April 17.2018; June 15, 2018; September 17, 2018; and January 15, 2019. Enter applicable amounts) ana rota payment in me coxes to me ngnr. 2018 IT-2105 on your payment. Make payable to Processing Center. Pp Box 4122, Binghamton NY vont me can Tour °gas or your brsr or ta NYS Income Tax. Mail voucher and payrnen 13902-4122. Enter your 2-character special condition code if applicable (see/ pull SSN or taxpayer lu number *****9816 taxpayers hrst name and middle initial ANASTASIYA i axpayer s last name SIROOCHENKO Mailing address (number and street or PC box; see instructions) Apartment number 288 WEST 4TH ST laity, village, or post otnce NEW YORK btate NY ZIP code 10014 taxpayers e-mail address IT-2105 Estimated tax amounts payer ID number and to: NYS Estimated Income Tax, DONS Cents str) 45000. 00 New York Stale New YQIk City 15000. 00 Yonkers 00 KICTIK 00 Total payment 60000. 00 STOP: Pay this electronically on our website 0601181019 *****9816 9 EFTA00792041
2018 amounts) aria rota payment in me coxes to me nom. W 2018 IT-2105 on your payment. Make payable to Processing Center. P40 Box 4122, Binghamton NY imnr me um Tour marts or your brsr or ra S Income Tax. Mail voucher and payrnen 13902-4122. Enter your 2-character special condition code If applicable (see/ run SSN or taxpayer lu number *****9816 taxpayers hrst name and middle initial ANASTASIYA i axpayer s last name SIROOCHENKO Mailing address (number and street or PC box; see instruchons) Apartment number 288 WEST 4TH ST laity, village, or post otnce NEW YORK State NY ZIP code 10014 taxpayers e-mail address 768042 10.27.17 Department of Taxation and Finance Tips for Estimated Tax Did you know? You can pay your estimated tax electronically on our website with a debit from your checking or savings account. Visit us on the Web at www.tax.ny.gov to pay your estimated tax electronically. For assistance. see Form IT-21054, Instructions for Form IT-2105, Estimated Tax Payment Voucher forIndNlduals. To help us match your New York State estimated tax account to your New York State income tax return. and to avoid a delay in processing your return, please note the following: • Social security number (SSNytaxpayer identification OD) number - Make sure that the entire SSN used on your vouchers agrees with the number on your social security card and the number used on your New York State income tax return. If you use a taxpayer ID number, this number must agree with the number used on your New York State income tax retum. Failure to do so may result in monies not being properly credited to your account. • Name - Make 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: city. province or state, and then country (all in the City, village, or post office box). Follow the country's practice for entering the postal code. Do not abbreviate the country name. • Married taxpayers - Each married taxpayer should establish a separate estimated tax account. If you and your spouse each maintain an estimated tax account and file a joint New York State income tax return, we will credit the balances of both accounts to your joint income tax retum. • All filers must be sure to separately enter the amounts for New York State, New York City. Yonkers, and MCTMT; then enter the total n the Total payment box. Note: If there is no amount to be entered for one or more Ines, leave them blank. Do not staple or clip the check or money order to the voucher. Please detach any check stubs before mailing. Need help? Visit our website at www.tany.gov • get information and manage your taxes online • check for new online services and features Telephone assistance Automated income tax refund status: (518) 457-5149 Personal Income Tax Information Center. (518) 457.5181 To order forms and publications: (518) 457-5431 Text Telephone (TTY) Hotline (for persons with hearing and speech disabilities using a TTY): If you have access to a TTY, contact us at (518) 485-5082. If you do not own a TTY, check with independent living centers or community action programs to find out where machines are available for public use. Persons with disabilities: In compliance with the Americans with Disabilities Act. we will ensure that our lobbies, offices, meeting rooms, and other facilities are accessible to persons with disabilities. If you have questions about special accommodations for persons with disabilities, call the information center. NEW Department of Taxation and Finance YORK STATE Estimated Tax Payment Voucher for Individuals New York State • New York City • Yonkers • MCTMT Detach (cut) here OP Calendar-year filer due dates: April 17.2018; June 15, 2018; September 17, 2018; and January 15,2019. Enter applicable payer ID number and to: NYS Estimated Income Tax, str) New York Stale 0 00 New YQIk City 0 00 Yonkots 00 KICTIK 00 Total payment 0 00 IT-2105 Estimated tax amounts STOP: Pay this electronically on our website 0601181019 *****9816 9 EFTA00792042
2018 amounts) ana mum payment in me coxes to me ngnr. 2018 IT-2105 on your payment. Make payable to Processing Center. Pp Box 4122. Binghamton NY vimr me um Tour agrts or your sbN or re NYS Income Tax. Mail voucher and payrnen 13902-4122. Enter your 2-character special condition code if applicable (see/ pull SSN or taxpayer lu number *****9816 taxpayers hrst name and middle initial ANASTASIYA i axpayer s last name SIROOCHENKO Mailing address (number and street or PC box; see instructions) Apartment number 288 WEST 4TH ST Lily, village, or post otnce NEW YORK btate NY ZIP code 10014 taxpayers e-mail address 768012 10.27.17 Department of Taxation and Finance Tips for Estimated Tax Did you know? You can pay your estimated tax electronically on our website with a debit from your checking or savings account. Visit us on the Web at www.tax.ny.gov to pay your estimated tax electronically. For assistance. see Form IT-21054, Instructions for Form IT-2105, Estimated Tax Payment Voucher forIndNlduals. To help us match your New York State estimated tax account to your New York State income tax return. and to avoid a delay in processing your return, please note the following: • Social security number (SSNytaxpayer Identification OD) number - Make sure that the entire SSN used on your vouchers agrees with the number on your social security card and the number used on your New York State income tax return. If you use a taxpayer ID number, this number must agree with the number used on your New York State income tax retum. Failure to do so may result in monies not being properly credited to your account. • Name - Make 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 retum. • Foreign addresses - Enter the information in the following order: city. province or state, and then country (all in the City, village, or post office box). Follow the country's practice for entering the postal code. Do not abbreviate the country name. • Married taxpayers - Each married taxpayer should establish a separate estimated tax account. If you and your spouse each maintain an estimated tax account and file a joint New York State income tax return, we will credit the balances of both accounts to your joint income tax retum. • All filers must be sure to separately enter the amounts for New York State, New York City. Yonkers, and MCTMT: then enter the total n the Total payment box. Note: If there is no amount to be entered for one or more Ines, leave them blank. Do not staple or clip the check or money order to the voucher. Please detach any check stubs before mailing. Need help? Visit our website at www.tany.gov • get information and manage your taxes online • check for new online services and features Telephone assistance Automated income tax refund status: (518) 457.51491 1, Personal Income Tax Information Center. (518) 457-5181 To order forms and publications: (518) 457-5431 Text Telephone (TTY) Hotline (for persons with heating and speech disabilities using a TTY): If you have access to a TTY, contact us at (518) 485-5082. If you do not own a TTY. check with independent living centers or community action programs to find out where machines are available for public use. Persons with disabilities: In compliance with the Americans with Disabilities Act. we will ensure that our lobbies, offices, meeting rooms, and other facilities are accessible to persons with disabilities. If you have questions about special accommodations for persons with disabilities, call the information center. NEW Department of Taxation and Finance YORK STATE Estimated Tax Payment Voucher for Individuals New York State • New York City • Yonkers • MCTMT 41 Detach (cut) here Calendar-year flier due dates: April 17.2018; June 15, 2018; September 17, 2018; and January 15,2019. Enter applicable payer ID number and to: NYS Estimated Income Tax, stir) L 80000 00 Now York Stale New Y0.14 CRY 55000 00 Yonkots 00 KICTIM 00 Total payment 135000 00 IT-2105 Estimated tax amounts STOP: Pay this electronically on our vrebsite 0601181019 *****9816 9 EFTA00792043
SEIS:101 1I 17, It NEW YORK STATE 2017 Department of Taxation and Finance Resident Income Tax Return New York State • New York City • Yonkers • MCTMT For the full year January 1, 2017, through December 31, 2017, or fiscal year beginning and ending , I T 2 0 1 tor neip compieung your return, see me insuuctions, rorm I i-nrt-i. Your IMI name MI Yom last name dor a pinmeturn, enter spouse's name on line WOO Your IIIMS DI WM (mm&WIFY) Your 0000l 00004 number ANASTASIYA SIROOCHENKO 07301987 *****9816 Spouse's first name MI Spouse's last narna Spouse's data Of Milk gnerddyni Spouse's soca sonny number Mailing address [see instructions. page 13) punts and street or PO 00 ) Adularia anew New York State county al residence 288 WEST 4TH ST NY City. village. a coeliac. State 2P code Country (U not U Mad Slates/ School Petra name NEW YORK NY 10014 MANHATTAN Taxpayer's permanent home address (see instructions. papa M)N/Abet and street anal ran) narkneint molar School district code number 369 ofty.village. Or post 'no Stale ZIP code Tavayer's date of &et rnmOlyin) Spas° s 64 of dot fonnedWr)/ NY Ikadolt inktrreton A Filing status (math an X in one box): O El Single @ Married filing joint return LJ (enter spouse's social security number above) m Married filing separate return LJ (enter spouse's social security number above) 0 D Head of household (with qualifying person) 0 D Qualifying widow(es) with dependent child B Did you Itemize your deductions on your 2017 federal income tax return? Yes ID No D C Can you be claimed as a dependent on anothe taxpayer's fede al return? Yes K No LI 1 H Dependent exemption inforrna ion (see Page 15) First name MI Last name Relationship canal security number Date of birth OninddyyYY) D1 Did you have a fnancial account located in a foreign country? (see page 14) Yes W No K D2 Yonkers residents and Yonkers part-year residents only: Did you receive a property tax relief credit? (1) (seepage 14) Yes K No K (2) Enter the amount .00 D3 Were you requred to report, under M. 110343, Div. C, §801(d)(2). any nonqualified deferred compensation on your 2017 federal return? (seepage 14) Yes K No El E (I) Did you or your spouse maintain living quarters in NYC during 2017? (see page 14) Yes K No K (2) Enter the number of days spent in NYC in 2017 (any part of a day spent in NYC is considered a day)... F NYC residents and NYC part-year residents only (seepage 14): (1) Number of months you lived it NYC In 2017 365 (2) Number of months your spouse lived in NYC in 2017 G Enter your 2-character special condition code(s) if applicable (see page 14) 12 If more than 7 dependents. mark an X in the box. IIIII 11111211111iiiih HIE For office use only NO HANDWRITTEN ENTRIES, OTHER THAN SIGNATURE, ON THIS FORM EFTA00792044
Page 2 of 4 1T-201 (2017) Mots social security number 768002 114T-1T Federal income and adjustments *****9816 (see page 15) 1 Wages, salaries, tips, etc. 2 Taxable interest income 3 Ordinary dividends 4 Taxable refunds, credits, or offsets of state and local income taxes (also enter on AS 25) 5 Alimony received 6 Business income or loss (submit a copy of federal Schedule Cot C-EZ, Form 1040) 7 Capital gain or loss (if required, submit a copy of federal Schedule D, Form 1040) 8 Other gains or losses (submit a copy of federal Form 4797) 9 Taxable amount of IRA distriputions. If received as a beneficiary, mark an X in the box 10 Taxable amount of pensions and annuities. If received as a beneficiary. mark an X in the box 11 Rental real estate, royalties, partnerships, S corporations, trusts, etc. (submit copy of federal Schedule E, Form 1040) 12 Rental real estate included in line 11 13 Farm income or loss (submit a copy of federal Schedule F, Form 1040) 14 Unemployment compensation 15 Taxable amount of social security benefits (also enter on line 27) 16 Other income (we Page 15) I identifY: 17 Add lines 1 through 11 and 13 through 16 18 Total federal adjustments to income eon pay IS) I ideneky: SEE STATEMENT 1 Whole dollars only 1 .00 2 755.00 3 .00 4 .00 5 .00 6 1572867.00 7 .00 8 .00 9 .00 10 .00 11 .00 121 .00 19 Federal adjusted gross Income (subtract line 18 from line 17) New York additions (see Pogo 10 20 Interest income on state and local bonds and obligations (but not those of NYS or its local governments) 21 Public employee 414(h) retirement contributions from yo s tatements (seepage 16) 22 New York's 529 college savings program distributions 23 Other (Form 1T-225, line 9) 24 Add lines 19 through 23 New York subtractions (see page 17) 25 Taxable rotund., an,,. or allots 01 µate and local income taxes loom lino 4) 25 00 26 Pensions of NY$ and local governments and the Waal government (sae page I7) 26 .00 27 Taxable amount of social security benefits (from line 15) 27 .00 28 Interest income on U.S. government bonds 28 .00 29 Pension and annuity income exclusion (see page 18) 29 .00 30 New York's 529 college savings program deduction/eamIngs 30 .00 31 Other (Form 17-225, line 18) 31 .00 32 Add lines 25 through 31 33 New York adjusted gross Income (subtract fine 32 from fine 24) Standard deduction or itemized deduction (see page 20) 34 Enter your standard deduction (table on page 20) or your itemized deduction (from F0=17-201-O) Mark an X in the appropriate box: K Standard D Itemized 35 Subtract line 34 from line 33 (If line 34 is more than line 33, leave blank) 36 Dependent exemptions (enter the number of dependents listed in Item H; see page 20) 37 Taxable Income (subtract fine 36 from line 35) Hill III Ill 11 Ill 13 .00 14 .00 15 .00 16 .00 17 1573622.00 18 32785.00 19 1540837.00 20 .00 21 .00 22 .00 23 70000.00 24 1610837.00 32 33 .00 1610837.00 34 11000 oo as 1599837.00 36 000.00 37 1599837.00 NO HANDWRITTEN ENTRIES, OTHER THAN SIGNATURE, ON THIS FORM EFTA00792045
Your social securit number 76131303 11-1( 17 Name(s) as shown on page I ANASTASIYA SIROOCHENKO Tax computation, credits, and other taxes 38 Taxable income (from line 37 on page 2) 38 1599837.00 39 NYS tax on line 38 amount (see page 21) 39 141106.00 40 NYS household credit (page 21, table 1. 2, or 3) 40 .00 41 Resident credit (see page 22) 41 .00 42 Other NYS nonrefundable credits (Form IT-201-ATT, fine 7) 42 .00 43 Add lines 40, 41, and 42 43 .00 44 Subtract line 43 from line 39 (if line 43 is more than line 39, leave blank) 44 141106.00 45 Net other NYS taxes (Form IT-201-ATT. fine 30) 45 00 46 Total New York State taxes (add lines 44 and 45) 46 141106.00 *****9816 IT-201 (2017) Page 3 of 4 New York City and Yonkers taxes, credits, and surcharges, and MCTMT 47 NYC resident tax on line 38 amount (see page 22) 47 61885 .00 48 NYC household credit (page 22, table 4, 5, or 6) 48 .00 49 Subtract line 48 from line 47 plume 48 is more than Una 47, leave blank) 49 61885 .00 50 Panyear NYC resident tax (Form IT-360.1) 50 .00 51 Other NYC taxes (Form IT-201-ATT, line 34) 51 .00 52 Add lines 49, 50, and 51 52 61885 .00 53 NYC nonrefundable credits (Form IT-201-ATT, fine 10) 53 14976 .00 54 Subtract line 53 from line 52 (11 kV 53 is more than Una 52, leave blank) 54 46909 .00 Ma MCTMT net earnings base Islet 1452543 .00 54b MCTMT Mb 4939 .00 55 Yonkers resident income tax surcharge (see page 25) , 55 .00 56 Yonkers nonresident eamings tax (Form V-203) 56 .00 57 Part-year Yonkers resident income tax surcharge (Form IT-360.1) 67 .00 58 Total New York City and Yonkers taxes / surcharges and MCTMT (add lines 54 and 54b through 57) 59 Sales or use tax (see page 26; do not leave line 59 blank ) 04'pr Voluntary contributions (see page 27) 60a Return a Gift to Wildlife 60a .00 60b Missing/Exploited Children Fund 60b .00 60c Breast Cancer Research Fund 60c .00 60d Alzheimer's Fund 60d .00 60e Olympic Fund (52 a $4; see page 27) 60e .00 601 Prostate and Testicular Cancer Research and Education Fund 601 .00 60g 9/11 Memorial 60g .00 60h Volunteer Firefighting & EMS Recruitment Fund 60h .00 601 Teen Health Education 60i .00 60) Veterans Remembrance 60) .00 60k Homeless Veterans 60k .00 60I Mental Illness Anti-Stigma Fund 601 .00 60m Women's Cancers Education and Prevention Fund 60m .00 60n Autism Fund 60n .00 60o Veterans' Homes 60o 00 60 Total voluntary contributions (add fines 60a through 60o) 61 Total Now York State, New York City, Yonkers, and sales or use taxes, MCTMT, and voluntary contributions (add lines 46, 58, 59, and 60) Hic o See instructions on pages 22 through 25 to compute New York City and Yonkers taxes, credits, and surcharges, and MCTMT. 51848.00 sal 59 0.0o 60 .00 61 192954.00 NO HANDWRITTEN ENTRIES, OTHER THAN SIGNATURE, ON THIS FORM EFTA00792046
Page 4 of 4 IT-201 (2017) Your social security umber 765004 11.17.17 62 Enter amount from line 61 816 IPayments and refundable credltel (see pages 28 through 31) 63 64 65 66 67 Empire State child credit NYS/NYC child and dependent care credit 63 .00 64 .00 NYS earned income credit (BC) 65 .00 NYS noncustodial parent EIC Real property tax credit 66 .00 67 .00 68 College tuition credit 68 400 oo 69 NYC school tax credit (fixed amount) (oho complete F on pager) 69 .00 69a NYC school tax credit (rate reduction amount) 69a .00 70 NYC earned income credit 70 .00 70a NYC enhanced real property tax credit 70a .00 71 Other refundable credits (Form 1T-201-ATT, line 18) 71 .00 72 Total New York State tax withheld 72 .00 73 Total New York City tax withheld 73 .00 74 Total Yonkers tax withheld 74 .00 76 Total estimated tax payments and amount paid with Form IT•370 75 205000 .00 76 Total payments (add lines 63 through 75) 62 192954.00 Your refund, amount you owe, and account information (see pages 31 through 34) 77 Amount overpaid Of line 76 is more then line 62, subtract line 62 from line 76) 78 Amount of line 77 to be refunded direct deposit to checking or n Mark one refund choice: ❑savings account (1111 in one sa) -01*- 79 79a 80 81 82 83 K ImPat check Amount of line 77 that you want applied to your 2018 estimated tax (see instructions) Amount of line 77 that you want as a NYS 529 account deposit (submit Form IT-195) Amount you owe (if line 761s less then fine 62, subtract line 76 from line 62). To pay by electronic funds withdrawal, mark an X in the box K and fill in lines 83 and 84. If you pay by check or money order you must complete Form IT201N and mail it with your return Estimated tax penalty (Include this amount in line 80 or reduce the overpayment on line 77; see page 32) Other penalties and interest (see page 32) Account information for direct deposit or electronic funds withdra val (see page 33). If the funds for your pnment (or refund) would co K me from (or go to) an account outside the U.S., mark an X in this K box (see pg. 33) If applicable, complete Fonn(s) IT-2 and/or IT-1099-R and submit them with your return (see page 12). Do not send federal Form W-2 with your return. 76 205400.00 LESS LN 81 77I 12317.00 78 .00 12317 .00 Refund? Direct deposit is the easiest fastest way to get your refund. See page 32 for payment options. 80 00 79 794 .00 81 129 oo 82 .00 See page 35 for the proper assembly of your return. 8:3a Account type: Personal checking - or - Personal savings - or - D Business checking - or - Business savings 83b Routing number 83c Account number 84 Electronic funds withdrawal (see page 33) Date Amount .00 Third-party designee? (see Instr.) Yesird Non • Paid preparer must complete' ,fttlx, 'Yr erfuvrirralb NeomeesslimMve DAVID WEISS Print designee's name DAVID WEISS Email: [email protected] Designee's phone number 212-695-5771 Personal identification number (RN) 13349 Preparea pinion' name DAVID WEISS Fame name (er yoke.. a soltuproloyed) DAVID WEISS CPA, PLLC PMPOrere PON or $91 P00962062 mews 183 MADISON AVE SUITE 803 NEW YORK, NY 100164403 F. I [email protected] Employer clentiOcation number *****2756 Dale • Taxpayer(s) must sign here • VOW WWI.* yore occupation ART DEALER Spouse's signature aid 00CupaniMMIOInt MUM Data Daytime phone number 646-528-5121 See instructions for where to mall your return. 201004171019 NO HANDWRITTEN ENTRIES, OTHER THAN SIGNATURE, ON THIS FORM EFTA00792047
NEW YORK STATE 2017 See the instructions for completing Form IT•201•ATT in the instructions for Form IT•201. Submit this form with your Form 11-201. Name(s) as shown on 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 instructions) Department of Taxation and Finance Other Tax Credits and Taxes Attachment to Form IT-2O1 IT-2011ATT Part 1 - O her New York State, New York City, and Yonkers ax credits Section A - New York State nonrefundable, non-carryover credits used 1 Accumulation distribution credit (submit computation) 2 Other nonrefundable, noncanyover credits Code Amount .00I El Code Total other nonrefundable, noncarryover credits (addlines 2a and 2b) Section B - New York State nonrefundable, carryover credits used 3 Longterm care insurance credit 4 Investment credit Amsted 5 Solar energy system equipment credit 6 Other nonrefundable• carryover credits Code Amount 6a 6b 6c 6d 6e 6f 69 .00 .00 .00 .00 .00 .00 .00 .00 code Amount 6h .00 61 .00 S .00 6k .00 64 .00 6m .00 6n .00 Total other nonrefundable. carryover credits (add lines 6a through 6n) 7 Total New York State nonrefundable credits used (add lines I through 6: enter here and on Form 17-201, line 42) Section C - New York City nonrefundable, non-carryover credits used 8 New York City resident UST credit 8a New York City resident GCT credit 9 New York City accumulation distribution credit (submit computation) 9a Part•year resident nonrefundable NYC child and dependent care credit 10 Total other New York City nonrefundable credits used (add lines 8.8a. 9. and 9a: enter here and on Porn; 17-201, line 53) Yes No El O Whole dollars only 1 .00 21 .00 3 .00 4 .00 5 .00 .00 1 7 .00 8 14976.00 8a .00 9 .00 9a .00 10 14976.00 Section D - New York State, New York City, Yonkers, and MCTMT refundable credits 11 Farmers' school tax credit 12 Other refundable credits Code 12a 12b 12c 12d 12e 121 Total other refundable credits (add lines 12a through 120 13 Add lines 11 and 12 Code Amount Rg_ .00 12h .00 12i .00 .00 12k .00 121 .00 241001171019 o 111 (continued on page 2) 11 .00 12 13 .00 .00 EFTA00792048
768062 09.05-17 IT-201-ATT (2017) (page 2) You' sockalsecunty number Part 1, Section D - New York State, New York City, Yonkers, and MCTMT refundable credits (continued) 14 Enter amount from line 13 on page 1 15 New York State claim of right credit 16 New York City claim of right credit 17 Yonkers claim of right credit 17a MCTMT (metropolitan commuter transportation mobility tax) claim of right credit 18 Total New York State, New York City, Yonkers, and MCTMT other refundable credits (add lines 14 through 17a; enter here and onForm IT-201, One 71) Part 2 - Other New York State taxes (submit all applicable forms) If you are subject to other New York State taxes, complete Part 2. 19 New York State tax on capital gain portion of lumpeum distributions (Form IT-230) 20 Other New York State taxes Code Amount 20a 20b 20c 20d 20e 201 .00 .00 .00 .00 .00 .00 2_0a 20h 201 201 20k 201 Code Total other New York State taxes (add lines 20a th ough 20!) Amount *****9816 14 .00 15 .00 16 .00 17 .00 7a .00 18 .00 19 .00 .00 .00 .00 .00 .00 .00 21 Add lines 19 and 20 22 See instructions for line 22 23 Enter amount from Form IT-201, line 39 24 26 22 23 .00 .00 Subtract line 23 from line 22 (If line 23 Is more than line 22, leave blank) Subtract line 24 from line 21 (If line 24 is more than One 21. leave blank) 26 New York State separate tax on lump•sum distributionsI (Form IT-230) 27 Resident credit against separate tax on lumpeum 26 1 .00 distributions 127 I 28 Subtract line 27 from line 26 .00 29 This line intentionally left blank 30 Net other New York State taxes (add lines 25 and 28: enter here and onForm IT-201, line 45) Part 3 - Other New York City taxes (submit all applicable forms) 31 This line intentionally left blank 32 New York City resident separate tax on lumpsum distributions (Form IT-230) 33 New York City tax on capital gain portion of lumpsum distributions (Form IT-230) 34 Total other New York City taxes (add lines 32 and 33; enter here and onForm IT-201, line 51) 241002171019 V III II III 1 III III 11111 III 1 I II H III 20 1 .00 21 .00 24 .00 25 .00 281 .00l 29 .00 31 32 .00 33 .00 114 .00 NO HANDWRITTEN ENTRIES ON THIS FORM EFTA00792049
NEW YORK STATE 2017 21]Ml• OD CR V Department of Taxation and Finance Resident Itemized Deduction Schedule IT-201-D Submit this form with Form IT-201. See instructions for completing Form 11.201O in the instructions for Form IT•201. Name(s) as shown en your Form IT.201 Your social security number ANASTASIYA SIROOCHENKO *****9816 1 Medical and dental expenses (federal Schedule A, line 4) 2 Taxes you paid (federal Schedule Aline 9) 3 Interest you paid (federal Schedule A, line 15) 4 Gifts to charity (federal Schedule A, fine 19) 5 Casualty and theft losses (federal Schedule A line 20) 6 Job expenses/miscellaneous deductions (federal Schedule A, fine 27) 7 Other miscellaneous deductions (federal Schedule A, line 28) 8 Enter amount from federal Schedule A, line 29 TATEMENT 2 9 State. local. and foreign income taxes (or general sales tax, If appkab and ether subtraction adjustments (see Instructions) 10 Subtract line 9 from line 8 11 Addition adjustments (see instructions) 12 Add lines 10 and 11 13 Itemized deduction adjustment (see instructions) 14 Subtract line 13 frcrn line 12 STATEMENT 3 15 College tuition itemized deduction (see Form IT-272) 16 New York State itemized deduction (add lines 14 and 15; enter on Form 1T-201, line 34) 201005171019 ~IIIl 111111 II II 1111111 III 1 III H III Whole dollars only 1 .00 2 214641.00 3 .00 4 22000.00 5 .00 6 .00 7 .00 8 198261.00 9 179826 oo 10 18435.00 11 4500 oo 12 22935.00 13 11935.00 14 3.1000.00 15 .00 16 3.1000.00 NO HANDWRITTEN ENTRIES ON THIS FORM EFTA00792050
NEW YORK STATE 2017 Submit Form IT-219 with your return. Form IT-201. Form IT-203. or Form IT-205. Department of Taxation and Finance Credit for New York City Unincorporated Business Tax Name(s) as shown on return ANASTASIYA SIROOCHENKO 768)11 II•!3,t1 I T ▪ 2 1 9 Taxpayer identdcation number (SSN or EIN) 9816 Part 1 - Partner (see instructions) Name of partnership (as shown on Form NYC-204) Partnership year end from Fam NYC.204) Partnership EIN 1 Enter the amount from Form NYC•204, line 23 (see insts.) 2 Enter the amount from Form NYC-204, line 20 (see inStr.) 3 Add Ines 1 and 2 4 Enter your percentage of total distributive shares from Form NYC•204, Schedule C, column I. Enter amount as a decimal and round to the fourth decimal place (for examPle. 17.5% =.1750) 5 Multiply line 3 by line 4 01 more than one business. see instructions) 1 2 .00 .00 31 4 5 .00 .00 Part 2 - Individual A 6 Resident individual: Enter the amount from Form NYC-202. line 21, or Form NYC.202S. Lie 8 (see friStr.) Part-year resident Individual: Enter the amount from Worksheet A, line 5 (on page 2) el 65115.00 Part 3 - Beneficiary's share of unincorporated business taxes (see Instructions) 7 Beneficiary - Enter your share of New York City unincorporated business taxes imposed on the estate or trust (see insinictions) Name of estate or trust Employer identification number 7 .00 Part 4 - Computation of credit 8 Fiduciaries: Enter the amount from Schedule A, Fiduciary line, column D (on page 2; see instr.) All others: Add lines 5, 6. and 7 (partners, see instructions) 9 Enter your taxable income from: Full-year NYC resident individuals - Form IT-201, line 37 Pal-year NYC resident Individuals - Form IT360.1. line 47 Full-year NYC resident estates or trusts - Form 17.205, line 5 Part-year NYC resident trusts - Form IT-205A. line 10. col. (b) 8 65115.00 9 1599837.00 10 If line 9 above is: — $42,000 or less. enter 1.000 (100%) — more than $42.000. but less than $142,000, complete Worksheet B (on page 2) — $142,000 or more, enter .230 (23%) 11 Multiply line 8 by line 10. New York City resident Individuals - Continue on line 12 below. NYC part-year resident individuals: Stop: enter line 11 amount on Form IT-360.1, line 54. Estates and trusts: Stop: enter kne 11 amount on Form IT-205, line 22 New York City full-year resident Individuals 12 Amount from Form IT•201. line 49 13 Amount from Form IT-201401T, line 32 14 Amount from Form IT-20VATT, line 33 15 Add Ines 12. 13. and 14 16 Enter the lesser of line 11 or 15, and transfer the amount to Form If-201•ATT, line 8 219001171019 III IIII III 1 II IIII III! I III I III II III 10 .230 11 14976.00 12 61885.00 13 .00 14 .00 15 61885.00 16 14976.00 EFTA00792051
IT-219 (2017) (Page 2) 768212 11.13-17 1 2 3 4 5 Worksheet A Enter the amount from Form INC-202, line 21, Form NYC-202EIN, line 21, or Form NYC•202S, line 8 Individuals: Enter the amount from Form IT560.1, line 6, column B Trusts: Enter the amount from Form IT-205A, Schedule 4, line 16, column C 1 .00 (see instructions) 2 .00 Individuals: Enter the amount from Form IT-360.1,11e 6, column A Trusts: Enter the amount from Form IT-205A, Schedule 4, line 16, column A (see instructions) 3 .00 Divide line 2 by line 3 and round the result to the fourth decimal place 4 Multiply line 1 by line 4. This is the pait•year resident tax imposed on the unincorporated business. Estates and trusts: Include this amount (below) in Schedule A. Totals line, column D. All others: Transfer this amount to line 6 on page 1 5 .00 Worksheet B 1 Base percentage 100% 1 1.000 2 Enter your taxable income from page 1, line 9 2 .00 3 Base amount $42500.00 4 5 6 7 Subtract line 3 from line 2 4 .00 Divide line 4 by $100,000 and rand to the third decimal place Multiply line 5 by .770 Subtract line 6 from Ilne 1. Transfer this decimal amount to page 1. line 10 7 Schedule A (for estates and trusts only) Fiduciary's and beneficiary's share of New York City unincorporated business tax A Name and address of beneficiary B Beneficiary's identifying number C Allocation percentage D Beneficiary's eligible unincorporated business taxes Totals 100% .00 .00 .00 .00 Fiduciary .00 III III III 11 III EFTA00792052
YEW YORK STATE 2017 Department of Taxation and Finance New York State Modifications Attachment to Form IT-201, IT-203, IT-204, or IT-205 789,391 I" Name(s) as shown on return Identifying number as shown on return ANASTASIYA SIROOCHENKO *****9816 Complete all parts that apply to you; see instructions (Form 11-225-I). Submit this form with Form IT-201, IT-203, 11-204, or IT-205. Mark an X in the box identifying the return you are filing: IT 201 X IT 203 IT 204 IT 205 Schedule A - New York State additions (enter whole dolla s sun)) Part 1 - Individuals, partnerships, and estates or trusts 1 New York State additions la lb lc td lc lf lq Number A- 201 A - A - A - A - A - A - A - Iota: amount 70000.00 .00 .00 .00 .00 .00 .00 B - NYS allocated amount .00 .00 .00 .00 .00 .00 .00 2 Total (add column A, lines la through I g) 3 Total of Schedule A. Part 1, column A amounts from additional Form(s)M225. if an:, 4 Add lines 2 and 3 2 70000.00 3 .00 4 70000.00 Part 2 - Partners, shareholders, and beneficiaries a Form 1.201 filers: do not enter EA-113 Form 1.203 filers: do not enter EA-113 Form 1.205 filers: do not enter EA-113 or 20 EA:I * * 5 New York State additions 53 5b Sc 5d Sc 5t 59 Number EA - EA - EA - EA - EA - EA - EA - A - Total amount 00 00 00 00 00 .00 .00 B - NYS allocated amount .00 .00 .00 .00 .00 .00 .00 6 Total (add column A lines 5a through 5g) 7 Total of Schedule A, Pan 2, column A amounts from additional Form(s) 1.225, If any 8 Add lines 6 and 7 9 Total additions (add lines 4 and 8; see instructions) 225001171019 HI III III 1 II 1111 IIII 1 III 1 III II III 6 .00 7 .00 8 .00 9 70000.00 (continued) NO HANDWRITTEN ENTRIES ON THIS FORM EFTA00792053
IT-225 (2017) (page 2) 785392 11.l6-li Schedule B - New York State subtractions (enter whole dollars onlY) Part 1 - Individuals, partnerships, and estates or trusts 10 New York State subtr 10a 10b 100 10cl 10e 10f lOg Number S S S - S - S - S S - tenons A - Total amount 00 00 00 00 00 00 .00 B - NYS allocated amount .00 .00 .00 .00 .00 .00 .00 11 Total (add column A, lines 10a through fog) 12 Total of Schedule B. Part 1, column A amounts from additional Form(s) if any 13 Add lines 11 and 12 Part 2 - Partners, shareholders, and beneficiaries a Form 1T•201 filers: do not enter ES-106, ES-107, or ES•125 Form 1T•203 filers: do not enter ES-106, ES-107, or ES•125 Form 1T•205 filers: do not enter ES-125 14 New York State subtractions 143 14b 14c 14d 14e 14f 14g Number ES - ES - ES - ES - ES - ES - ES - A - Total amount 00 00 00 Go 00 00 00 16 Total (add column A, lines Ma through f 4g) 16 Total of Schedule B, Part 2, column A amounts from additional Form(s) IT225, If any 17 Add lines 15 and 16 18 Total subtractions (add fines 13 and 17; see instructions) 225002171019 VIII III III 1 III III 11111 III 1 III H III iii 4 . ' 11 .00 12 .00 19 .00 15 .00 16 .00 [Id .00 18 .00 NO HANDWRITTEN ENTRIES ON THIS FORM EFTA00792054
NEW YORK STATE 2017 Department of Taxation and Finance Claim for College Tuition Credit or Itemized Deduction Full-year New York State residents only Submit your completed Form 1T-272 with Form IT•201. See Form IT•2724, Instructions for Form IT-272. Your name as shown on return (first name first) Your social security number ANASTASIYA SIROOCHENRO *****9816 Spouse's name (first name first) Spouse's social security number Note: If you are married and filing separate New York State returns, you must also enter your spouse's name and social security number. 10-02.17 11-272 1 Are you claimed as a dependent on another taxpayer's New York State tax return for this tax year? El Yes D No W • If Yes, stop; you do not qualify for the college tuition credit or the college tuition itemized deduction. • If No, continue with question 2. 2 Were you (and your spouse if filing a Joint return) a New York State resident for all of this tax yea? • If Yes, continue with Part 1 below. • If No, stop; you do not qualify for the college tuition credit. However, you may qualify for the college tuition itemized deduction. For more information, see the instructions for Form 11203. Yes II No n Part 1 - In the spaces provided below, complete lines A through H for up to three eligible students for whom you paid qualified college tuition expenses. (If you are claiming expenses for more than three eligible students, see instructions.) A Eligible students name 1- Student 1 2- Student 2 3- Student 3 ANASTASIYA SIRO Eligible students social security B number (SSN) *****9816 Is the student claimed as a dependent C on your NYS return? (see instructions) Yes Fi No M Yes F-I No In Yes El No Fl D EIN of college or university (see Instr.) 135598093 E Name of coll or university (see Instr.) TRUSTEES OF COL Were expenses for undergraduate F tuition? (see instructions) Yes iri No n Yes Fl No In Yes El No n Amount of qualified college tuition G expenses (see instructions) 39018.00 .00 .00 H Enter the lesser of line G or 10.000 10000.00 .00 .00 3 Total qualified college tuition expenses (Add line H, columns 1, 2, and 3; include amounts from any additional sheets. Complete Part 2or Part 3 on page 2.) 272001171019 1111 fb 3 10000.00 NO HANDWRITTEN ENTRIES ON THIS FORM EFTA00792055
IT•272 (2017) (page 2 of 2) 76E+097 10.02.17 Part 2 - Complete Part 2 if your total qualified college tuition expenses on line 3 are less than $5,000. 4 Credit limitation ($200) 6 Enter the lesser of line 3 or line 4. This is your college tuition credit • If you did not itemize your deductions on your federal return, enter the line 5 amount on Form IT.201. line 68. • If you itemized your deductions on your federal return, continue with Part 4. Part 3 - Complete Part 3 if your total qualified college tuition expenses on line 3 are $6,000 or more. 6 Enter the amount from line 3 7 Multiply line 6 by 4% (.04). This is yourcollege tuition credit • If you did not Itemize your deductions on your federal return, enter the line 7 amount on Form IT•201, line 68. • If you itemized your deductions on your federal return, continue with Part 4. Part 4 - College tuition itemized deduction election 4 200.00 5 .00 6 10000 00 7 400 oo If you itemized your deductions on your federal return, you may elect to claim the college tuition Itemized deduction instead of the college tuition credit. To compute your college tuition itemized deduction, complete Worksheet 1 in the instructions for this form. To determine if you will receive a greater tax benefit from the itemized deduction or credit. complete Worksheet 2 in the instructions for this form. 8 Mark an X in this box only if you elect to claim the college tuition Itemized deduction • If you marked an X in the box at line 8. enter the amount from Worksheet 1. line 5 On the instructions for this form), on your itemized deduction schedule. Do not enter the college tuition credit from line 5 or 7 above on Form I7201. You are entitled to claim either the deduction or the credit, but not both. • If you did not mark an X in the box at line 8 and you elect to claim the college tuition credit instead of the college tuition itemized deduction, enter the line 5 or line 7 amount on Form IT201, line 68. 8 Important: If you are claiming the college tuition credit or the college tuition itemized deduction, you must submit Form 11272 with your return. 272002171019 NO HANDWRITTEN ENTRIES ON THIS FORM EFTA00792056
W YORK Underpayment of Estimated Tax IT-2105.9 STATE By Individuals and Fiduciaries 20171y New York State • New York City • Yonkers • MCTMT 1 5Name(s) as shown on return ANASTASIYA SIROOCHENKO Department of Taxation and Finance art 1 - All filers must complete this part(see instiuctions, Form IT-2105.9-I. for assistance) 1 Total tax from your 2017 return before withholding and estimated tax payments (caution. see instructions) Identification number (SSN or EIN) ***** 9816 2 Empire State child credit (from Form IT-201, fine 63) 3 NYS/NYC child and dependent care credit (from Form IT-201, fine 64) 4 NY State earned income credit (EIC) (from Form IT-201, Nne 65) 5 NY State noncustodial parent EIC (from Form IT-201, fine 66) 6 Real property tax credit (from Form IT-201, fine 67) 7 College tuition credit (from Form IT-207, fine 68) 7a Total amount of any check(s) received from the Tax Department for any school or property tax credits (see instructions) 8 NY City school tax credit Iron Form ir-201. Win 69 and 69e. or Form rr•ses. wire 50 and We) 9 NY City earned income credit (from Form IT-201, fine 70) 9a NY City enhanced real property tax credit (from Form IT-201, fine 70a) 10 Other refundable credits from Form IT.201. line 7 Form IT-203,m I; Or FCfm 1. 33) 11 Add lines 2 through 10 12 Current year tax (subtract line 11 from final) 13 Multiply line 12 by 90% (.90 14 Income taxes withheld Morn Form it.201, lines 72. 73, and 74: Form IT.203. lines 62.63. and 64: or Forin11.205. lines 31.35. and 36) 15 Subtract line 14 from line 12. If the result is less than $300. do not complete the rest of this form (see instructions) 16 Enter your 2016 tax (caution: see instructions) 17 Enter the smaller of line 13 or line 16 Part 2 - Short method for computing the penalty -Complete lines 18 through 24 if you paid withholding tax and/or paid four equal estimated tax instalments (on the due dates), or if you made no payments of estimated tax. Otherwise, you must complete Part 3 - Regular method. 18 Enter the amount from line 14 above 18 .00 19 Enter the total amount of estimated tax payments you made (see instructions) 19 .00 20 Add lines 18 and 19 20 .00 21 Total underpayment for yea'. Subtract line 20 from line 17 (if zero or less, you do not owe the penalty) 21 .00 22 Multiply line 21 by .04985 and enter the result 22 .00 23 If the amount on line 21 was paid on or after April 15. 2018. enter 0. If the amount on Me 21 was paid before April 15, 2018, make the following computation to find the amount to enter on this line: Amount on line 21 x number of days paid before Apt 15, 2018 x .00020 = 23 24 Penalty. Subtract line 23 from line 22 24 I 2 3 4 5 8 7 .00 .00 .00 .00 .00 400.00 7a .00 .00 .00 .00 .00 8 9 ga 10 131 173299.00 11 192954.00 11 400.00 12 192554.00 14 .00 192554.00 16 11859.00 17 11859.00 Enter here and on Form 1T-201, line 81: Form fT.203, line 71: or Form 11%205, line 42. Part 3 - Regular method - Schedule A - Computing your underpayment (Schedule e is on page 2) Payment due dates A 4/15/17 8 6/15/17 C 9/15/17 D 1/15/18 26 Required installments. Enter''/. of line 17 in each column. Ia you used the annualized income installment method. see hstrucnons,) 26 Estimated tax paid and tax withheld (see instructions) 25 1111.00 1112.00 1111.00 852 5.00 26 .00 .00 .00 205000.00 Complete lines 27 through 29, one column at a time, starting In column A. 27 Overpayment or underpayment from prior period 27 - 1111.00 - 2223.0o - 3334.00 28 If line 27 is an overpayment, add lines 26 and 27; if line 27 is an underpayment, subtract line 27 from line 26 (see Instr.) 29 Underpayment (subtract line 28 from fine 25) or overpayment (subtract line 25 from line 28; see instructions) 28 .00 - 1111.00 - 2223.00 201666.00 29 - 1111.00 - 2223.00 -3334.00 193141.00 III111111iiiiiiiiiii 11111 III EFTA00792057
IT-2105.9 ,:2O. 765052 10-24-17 Part 3 - Regular method - Schedule B - Computing the penalty Payment due dates B 6/15/17 C 9/15/17 D 1/15/18 30 Arnount of underpayment (from fine 29) First Installment (April 15 - June 15, 2017) 31 April 15 • June 15 = (61 365) x 7.5% = .01253 - or - April 15 • It365)x 7.5%. • 32 Multiply line 30. column A by line 31 30 31 32 1111 co 14 cc Second Installment (June 16 - September 15, 20 7) 33 June 15 September 15 = (92 + 365) x 7.5% = .01890 June 15. =( + 365) x 7.5% = • 34 Multiply line 30, column B by line 33 33 34 2223.00 42 3334.00 Third Installment (September 16, 2017 - January 16, 2018) 35 September 15. January 15 = (122 + 365) x 7.5% = .02506 September 15. =1 +365)x7. 36 Multiply line 30. column C by line 35 Fourth Installment (January 15 - April 15, 2018) 37 January 15 • April 15 = (90 • 365)x 7.5% = .01848 January 15 • =(I • 365)x 7.5% = • 35 36 73 cc) .00 37 38 Multiply line 30, column D by Ile 37 39 Penalty. Add lines 32, 34. 36, and 38. Enter here and on Form rp2ot, line 81; SEE ATTACHED UNDERPAYMENT WRSH i T2 9 Form IT•203, line 71: or Form IT205. line 42 1391 00 059002171019 H Submit this form with your New Yak State return. .00 38 EFTA00792058
Page 6 IT-2105.94 (2017) 965111 10-24-IT Worksheet 1 - Annualized income installment - New York State (Complete one column through line 26 before completing the next column.) 'Estates and trusts - Use the following ending dates in each column: 228/17, 4130/17, 7/31/17 and 11/30/17 a 1/1/17 - 3/31/17 b 1/1/1/• 5/31/17 c 1/1/1/ - 8/31/17 d 1/1/1/ • 12/31/17 1 New York adjusted gross income for period shown 1 0 . 0 . 0. 1610837. 2 Annualization amounts 2 4 2.4 1.5 1 3 Annualized New York adjusted gross income (multiply line 1 byline 2) 3 1610837. 4 Itemized deductions for period shown (if you do not itemize deductions, skip lines 4, 5, and 6). Estates and trusts - enter 0, skip to line 8 and enter the amount from line 3 on line 8 4 2750. 4583. 7333. 11000. 5 Annualization amounts 8 Multiply line 4 by line 5 7 Standard deduction 8 Subtract line 6 or line 7 from line 3 5 4 2.4 1.5 1 6 11000. 10999. 11000. 11000. 7 8 -11000. -10999. -11000. 1599837. 9 Multiply $1,000 by the number of dependent exemptions claimed. Estates and trusts • enter the federal exemption amount (enter full amount in each column) 9 10 Annualized taxable income (subtract line 9 from Une 8) 10 -11000. -10999. -11000. 1599837. 11 Resident individuals and resident estates and trust • compute the tax on the amount on line 10 11 O. O. O. 141106. 11a Nonresident and part•year resident individuals, nonresident estates and trusts and part-year resident trusts compute the tax on the amount on line 10 11a 11b Nowasaant and patina resident indroduals Onto' the applbable pollen of any craft darned on MOs 39. 41. and 43 of Form IT-203 11b 11c Subtract line 1 lb from line t la. If Ina I lb Is more than Ina Ila. leave blank 11d Nonresident and part•year resident individuals • Income percentage for period shown: Form IT-203, New York State amount column, line 31, for the period shown divided by 11C 11d 1-orm I i -2Us, kederai amount column, line it, for the period shown. Nonresident estates and trusts and part-year resident trusts • see instructions. Income percentage worksheet A 11e Multiply line 11c by line 11d 12 Enter the applicable portion of any credits claimed on Form IT-201, line 43: Form IT•203, Me 47: or Fo IT•205,1ine 10 Embiract line 2 from lino 11 or Ilne Ile. I line 12 Is min ihen lino 11w He. 1.4 laavebbnk 14 For each period, enter the total amount of other New York State taxes reported on Form IT•201, line 45: Form IT•203, line 49; or Form 11•205, line 12 11e 12 ' 13 0 . 0 . 0• 141106. 14 16 Add lines 13 and 14 18 Refundable credits (see instructions) 15 0 . 0 . 0 . 141106. 16 400. 400. 400. 400. 17 Total annualized tax (subtract fine 16 from line 15) 17 0 . 0 . O. 140706. 18 Percentage 19 Multiply line 17 by line 18 20 Enter the amount from line 25 of Worksheet 2, Fine 9 of Worksheet 3, and/or the amount from line 8 of Worksheet 4 18 22.5% 45% 67.5% 90% 19 0 . 0 . O. 126635. 20 1111. 2223. 3334. 46663. 21 Add lines 19 and 20 22 Add the combined amounts of line 26 from all preceding columns 23 Subtract line 22 from line 21. If less than zero, enter 0 24 For each payment period, divide the amount from Form IT-2105.9, line 17 by four, and add amount from this worksheet, line 25, preceding column 21 1111. 2223. 3334. 173298. 22 1111. 2223. 3334. 23 1111. 1112. 1111. 169964. 24 2965. 4819. 6672. 8525. 25 If Ine 24 is more than line 23. subtract line 23 from line 24 Otherwise enter 0 26 Required installments. Enter the smaller of line 23 or line 24 here and on Form IT.2105.9, line 25 25 1854. 3707. 5561. 26 1111. 1112. 1111. 8525. 1019 EFTA00792059
768112 ¶0.24.17 IT-2105.94 (2017) Page 7 Worksheet 2 - Annualized income installment - New York City Estates and trusts - Use the following ending dates in each column: 2/28/17,4130/17, 7/31/17 and 11/30/17 a 1/1/17 • 3131/17 b 1/1/17 • 5/31/17 c 1/1/17 8f31/17 d 1/1/17 12/31/17 1 New York City adjusted gross income for period 2 Annualization amounts (estates and trusts - see instructions) 3 Annualized New York City adjusted gross income (multiply line I by line 2) 4 Itemized deductions for period shown (If you do not itemize deductions, skip lines 4. 5 and 6). Estates and trusts • enter 0, skip to line 8 and enter the amount from line 3 on line 8 5 Annualization amounts 6 Multiply line 4 by line 5 7 Standard deduction 8 Subtract line 6 or line 7 from line 3 9 Multiply $1,000 by the number of dependent exemptions claimed. Estates and trusts - enter the federal exemption amount 10 Annualized taxable income (subtract line 9 from line 8) 11 Compute the tax on the amount on line 10 (see instructions) 12 Enter for each period the total amount of the New York City tax on the capital gain portion of any lump•sum distribution from Form IT-201•ATT, line 33; Form IT360.1. line 52; or Form IT205, line 16 13 Add lines 11 and 12 14 Enter the applicable portion of any credits claimed on Form IT-201, line 48; Form IT-201-ATT, lines 9 and 9a; Form IT-203, line 52; Form IT-360.1, line 49; or Form IT-205, line 18 15 Subtract line 14 from line 13. If line 14 is more than line 13, leave blank 16 For each period enter the New York City tax on the ordinary income portion of any lumpsum distribution from Form 11•201•ATT, line 32; Form IT-360.1, line 51; or Form 11205, line 20 17 Add lines 15 and 16 18 Enter the applicable portion of the New York City UBT and the GCT credit from Form TT•201 ATT, lines 8 and 82; Form 11360.1. line 54; or Forrn11205, line 22 19 Subtract line 18 from line 17 20 This line intentionally left blank 21 This line intentionally left blank 22 Enter the applicable portion of any credits claimed on Form IT-216, line 24; Form IT-201, line 70; Form 11-201-ATT, line 16; or Form IT-203-ATT, lines 9a, 11, and 15 23 Total annualized tax (subtract line 22 from line 19) 24 Percentage 26 Multiply line 23 by line 24. Enter the result here and include on Worksheet 1, line 20, in the proper column 1 2 1610837. 4 2.4 1.5 1 3 1610837. 4 5 6 7 8 2750. 4583. 7333. 11000. 4 2.4 10999. 1.5 11000. 1 11000. 11000. - 11000. - 10999. - 11000. 1599837. 9 10 11 - 11000. - 10999. - 11000. 1599837. 61885. 12 13 61885. 14 15 61885. 16 17 61885. 18 19 20 21 14976. 14976. 14976. 14976. 46909. 22 23 24 46909. 22.5% 45% 67.5% 90% 25 42218. 1019 EFTA00792060
Page 8 IT-2105.9-1 (2017) 768113 10-24.17 Worksheet 3 - Annualized Income installment - Yonkers Estates and trusts - Use the following ending dates in each column: 2/28/17, 4/30117, 7/31117 and 11/30/17 a 1/1/17. 3•/31/17 b 1/1/17. 5/31/17 c 1/1/17 - 8/31/17 d 1/1/17 • 12/31/17 1 Enter the amount from Worksheet 1, line 19 2 Percentage 3 Multiply line 1 by line 2 4 For each period, enter the Yonkers nonresident earnings tax from Form IT-201, line 56; Form IT-203, line 53; or Form IT-205, line 27 5 Percentage 6 Multiply line 4 by line 5 7 Add line 3 and line 6 8 Enter any amount from Form IT•201•ATT, line 17. or Form IT•203•ATT. line 16 9 Subtract line 8 from line 7. Enter here and include on Worksheet 1. line 20, in the proper column 1 2 16.75% 16.75% 16.75% 16.75% 3 4 5 22.5% 45% 67.5% 90% 6 7 8 9 Worksheet 4 - Annualized income Installment - MCTMT a 1/1/17 • 3/31/17 b 1/1/17 • 5/31/17 c 1/1/17- 8/31/17 d 1/1/17 • 12/31/17 1 Net earning from self•employment allocated to the MCTO for period shown (see ins:mations) 2 Annualization amounts 3 Multiply line 1 by line 2 4 Annualized MCTMT (multiply fine 3 by .34% f:0034,0 5 Percentage 6 Multiply line 4 by line 5 7 Enter any amount from Form IT.201•ATT, line 17a, or Form IT•203•ATT, line 16a 8 Subtract line 7 from line 6. Enter here and inckide on Worksheet!, line 20. in the proper column 1 363136. 605226. 968362. 1452543. 2 4 2.4 1.5 1 3 145154C 1452542. 1452543. 1452543. 4 493g. 4939. 4939. 4939. 5 22.5% 45% 67.5% 90% 6 1111. 2223. 3334. 4445. 7 8 1111. 2223. 3334. 4445. 1019 EFTA00792061
UNDERPAYMENT OF ESTIMATED TAX WORKSHEET NY I ANASTASIYA SIROOCHENKO d f • Hid f *** ** 9816 (13. Amount (C) Adjusted Balance Due (D) Number Days Balance Due :Ef Da I f PenaIffy Rate -0- 04/15/17 1,111. 1,111. 61 .000205479 14. 06/15/17 1,112. 2,223. 92 .000205479 42. 09/15/17 1,111. 3,334. 107 .000205479 73. 12/31/17 205,000. -201,666. 01/15/18 8,525. -193,141. Penalty Due (Sum of Column F). 129. • Date of estimated lax payment, withholding credit date or installment due date. 7 125 11 W451.17 EFTA00792062
ANASTASIYA SIROOCHENKO ***-**-9816 NY IT-201 FEDERAL ADJUSTMENTS TO INCOME STATEMENT 1 DESCRIPTION AMOUNT SE TAX DEDUCTION 28,949. SELF-EMPLOYED HEALTH INSURANCE 3,836. TOTAL TO FORM IT-201, LINE 18 32,785. STATEMENT(S) 1 EFTA00792063
ANASTASIYA SIROOCHENKO ***-**-9816 NY IT-201 WORKSHEET 2 - SUBTRACTION ADJUSTMENT LIMITATION STATEMENT 2 1. ENTER AMOUNT FROM FEDERAL ITEMIZED DEDUCTION WORKSHEET, LINE 9 2. ENTER AMOUNT FROM FEDERAL ITEMIZED DEDUCTION WORKSHEET, LINE 3 3. DIVIDE LINE 1 BY LINE 2 AND CARRY THE RESULT TO FOUR DECIMAL PLACES 4. AMOUNT OF STATE, LOCAL AND FOREIGN INCOME TAXES FROM FEDERAL SCHEDULE A, LINES 5 AND 8 5. AMOUNT OF SUBTRACTION ADJUSTMENTS (FROM ITEMIZED DEDUCTIONS) THAT ARE INCLUDED IN TOTAL FEDERAL ITEMIZED DEDUCTIONS FROM FEDERAL SCHEDULE A, LINE 29, BEFORE ANY FEDERAL DISALLOWANCE 6. ADD LINE 4 AND LINE 5 7. MULTIPLY LINE 6 BY LINE 3 8. SUBTRACT LINE 7 FROM LINE 6 9. ENTER ANY OTHER SUBTRACTION ADJUSTMENTS TO ITEMIZED DEDUCTIONS 10. ENTER THE AMOUNT FROM WORKSHEET 1, LINE 5 (SEE BELOW) 11. ADD LINES 8, 9, 10. ENTER THE TOTAL ON FORM IT-201-D, LINE 9 38,380 236,641 0.1622 214,641 0 214,641 34,815 179,826 0 179,826 WORKSHEET 1 LONG-TERM CARE ADJUSTMENT 1. AMOUNT OF LONG-TERM CARE PREMIUMS INCLUDED ON FEDERAL SCHEDULE A, LINE 1 2. AMOUNT FROM FEDERAL SCHEDULE A, LINE 1 3. DIVIDE LINE 1 BY LINE 2 AND CARRY THE RESULT TO FOUR DECIMAL PLACES 4. AMOUNT FROM FEDERAL SCHEDULE A, LINE 4 5. MULTIPLY LINE 4 BY LINE 3 0 STATEMENT(S) 2 EFTA00792064
ANASTASIYA SIROOCHENKO ***-**-9816 NY IT-201-D ITEMIZED DEDUCTION WORKSHEET - ADDITION ADJUSTMENTS STATEMENT 3 DESCRIPTION AMOUNT 2015 NYC TAXES PAID IN 2017 4,500. TOTAL TO FORM IT-201-D, LINE 11 4,500. k k STATEMENT(S) 3 EFTA00792065
DAVID WEISS CPA, PLLC 183 MADISON AVE SUITE 803 NEW YORK, NY 10016-4403 (212) 695-5771 OCTOBER 10, 2018 ANASTASIYA SIROOCHENKO 288 WEST 4TH ST NEW YORK, NY 10014 DEAR ANASTASIYA: ENCLOSED ARE YOUR 2017 NEW YORK CITY U.B.T. RETURN AND 2018 ESTIMATED TAX VOUCHERS. THIS RETURN HAS QUALIFIED FOR ELECTRONIC FILING. AFTER YOU HAVE REVIEWED YOUR RETURN FOR COMPLETENESS AND ACCURACY, PLEASE SIGN, DATE AND RETURN FORM NYC 579-UBTI TO OUR OFFICE BY MAIL, E-MAIL ([email protected]), OR FAX (212-695-5772). WE WILL THEN TRANSMIT YOUR RETURN ELECTRONICALLY TO THE NYC DOF, AND NO FURTHER ACTION IS REQUIRED. DO NOT MAIL THE PAPER COPY OF THE RETURN TO THE NYC DOF. RETURN FORM NYC 579-UBTI TO US AS SOON AS POSSIBLE (BY OCTOBER 15, 2018). YOUR OVERPAYMENT IN THE AMOUNT OF $3,067 HAS BEEN APPLIED TO YOUR BUSINESS DECLARATION OF ESTIMATED TAX. NO PAYMENT IS REQUIRED. NEW YORK CITY U.B.T. ESTIMATED TAX VOUCHERS: SIGN AND SEPARATELY MAIL THE DECLARATION OF ESTIMATED TAX FORM BY JANUARY 15, 2019. ENCLOSE YOUR CHECK FOR $63,000, PAYABLE TO NYC DEPARTMENT OF FINANCE. INCLUDE YOUR SOCIAL SECURITY NUMBER ON YOUR CHECK. MAIL TO - NYC DEPARTMENT OF FINANCE UNINCORPORATED BUSINESS TAX III. BOX 3923 NEW YORK, NY 10008-3923 FOR YOUR REFERENCE WE HAVE LISTED ALL ESTIMATED TAX PAYMENTS AND THEIR ORIGINAL DUE DATES BELOW. VOUCHER NO. 4 BY 01/15/19 $63,000 EFTA00792066
YOUR COPY OF THE RETURN IS ENCLOSED FOR YOUR FILES. WE SUGGEST THAT YOU RETAIN THIS COPY INDEFINITELY. VERY TRULY YOURS, DAVID WEISS EFTA00792067
NYC - 5UBTI 0,:ercItit :11 DECLARATION OF ESTIMATED UNINCORPORATED BUSINESS TAX (FOR INDIVIDUALS, ESTATES AND TRUSTS) For CALENDAR YEAR 2018 beginning and ending 2018 Fistmmanclofts ANASTASIYA Last name mm SIROOCHENKO Chang. SOCIAL SECURITY NUMBER * * * -**-9816 Business name SUBLIME ART LLC B1)1911ES5 COOE NUMBERAS PER FEDERAL RE T LH N 453920 Business address (number and sheet, Aileen 244 FIFTH AVENUE #1590 Olarig ia - City and Elate NEW YORK, NY ZIP coda 10001 Cam'? IX nt% us) ESTATES ANO 1RVSTS ONLY. ENTER EMPLOYER IDENTIFICATION NUMBER Business Telephone Number Taxpayer's Email Matas, A Payment 1. Estimate of 2018 tax Amount included with form • Make payable to: NYC Department of Finance A. 2. Amount to be paid with this declaration (Payable to: NYC DEPARTMENT OF FINANCE) 1. 2. aymen 65120. 0. Signature of taxpayer Data To receive proper credit, you must enter your correct Social Security Number or Employer Identification Number on your declaration and remittance. DETACH ON DOTTED LINE & MAIL UPPER PORTION. RETAIN LOWER PORTION FOR YOUR RECORDS 05 ESTIMATED TAX WORKSHEET • KEEP THIS PORTION FOR YOUR RECORDS • 1. Net income from business expected in 2018 (see instructions) 2. Exemption (see instructions) 3. Line 1 less line 2 (estimated taxable business income) 4. Tax • enter 4% of line 3(see instructions) 5a. Business Tax Credit (00 ) (Check applicable box below and enter credit amount) Tax on line 4 is $3,400 or less. Your credit is the entire amount of tax on line 4. Tax on line 4 is $5,400 or over. No credit is allowed. Enter "0". Tax on line 4 is over $3,400 but less than $5,400, use formula for credit amount: 1. 2. 3. 4. Tax on line 4 X ( $5.400 minus tax on line 4) 5a. $2,000 Et). Other credits (see Instructions) 6b. 6c. Total credits (add lines 5a and 5b) 6. Estimated 2018 Unincorporated Business Tax pine 4 less line 5c) 6c. Enter here, on line lb. and on line 1 of declaration above ADjUSTED TO 6. 65120. 7a. 2017 Unincorporated Business Tax 7a. 65115. 7b. Estimate of 2018 tax from line 6 7b. 65120. COMPUTATION OF INSTALLMENT - floe ) °tech proper box beton and Nike Amdahl hdicated. Faecal year taxpayers see Instructions. 8. If this declaration April 17, 2018, enter 1/4 of line lb Sept. 17, 2018, enter 1/2 of line 7b is due on: June 15, 2018, enter 1/3 of line lb X Jan. 15, 2019, enter amount of line 7b 8. 9. Enter amount of overpayment on 2017 return which you e ected to have applied as a credit against 2018 estimated tax 9. 10. Amount to be paid with this declaration pine 8 less line 9) (Payable to: NYC DEPARTMENT OF FINANCE) 10. 63000. Make remittance payable to the order of: NYC DEPARTMENT OF FINANCE Payment must be made in U.S. dollars, drawn on a U.S. bank. 794571 11-15.17 MAILING INSTRUCTIONS MAIL YOUR DECLARATION FORM TO: NYC DEPARTMENT OF FINANCE UNINCORPORATED BUSINESS TAX BOX 3923 NEW YORK. NY 10008.3923 NYC-51.18T1 2018 EFTA00792068
NYC - 5UBTI 0,:ercItit ,11;mt DECLARATION OF ESTIMATED UNINCORPORATED BUSINESS TAX (FOR INDIVIDUALS, ESTATES AND TRUSTS) For CALENDAR YEAR 2018 beginning and ending 2018 Fig ABM an, Initial I AV 0.-Vn9 Fiale Change — SOCIAL SECURITY NUMBER Business name BUSNESS CODE NUMBER AS PER FEDER/a HE TLHN SWIM'S address (number and street) Mitres* Caange — City and Sae ZIP coos I Cckinv? In n0 VS/ ESTATES ANO TRUSTS ONLY. ENTER EMPLOYER IDENTIFICATION NUMBER Business Telephone Runt. Taxpayer's Email Address aymonAmour' 1. Estimate of 2018 tax 2. Amount to be paid with this declaration (Payable to: NYC DEPARTMENT OF FINANCE) 1. 2. Signature of Caspar,/ Trio Date To receive proper credit, you must enter your correct Social Security Number or Employer Identification Number on your declaration and remittance. DETACH ON DOTTED LINE & MAIL UPPER PORTION. RETAIN LOWER PORTION FOR YOUR RECORDS 05 794672 11.15.17 EFTA00792069
NYC - 5UBTI 0,:ercItit ,11;mt DECLARATION OF ESTIMATED UNINCORPORATED BUSINESS TAX (FOR INDIVIDUALS, ESTATES AND TRUSTS) For CALENDAR YEAR 2018 beginning and ending 2018 Fig ABM an, Initial I AV 0.-Vn9 Fiale Change — SOCIAL SECURITY NUMBER Business name BUSNESS CODE NUMBER AS PER FEDER/a HE TLHN SWIM'S address (number and street) Mitres* Caange — City and Sae ZIP coos I Cckinv? In n0 VS/ ESTATES ANO TRUSTS ONLY. ENTER EMPLOYER IDENTIFICATION NUMBER Business Telephone Runt. Taxpayer's Email Address aymonAmour' 1. Estimate of 2018 tax 2. Amount to be paid with this declaration (Payable to: NYC DEPARTMENT OF FINANCE) 1. 2. Signature of Caspar,/ Trio Date To receive proper credit, you must enter your correct Social Security Number or Employer Identification Number on your declaration and remittance. DETACH ON DOTTED LINE & MAIL UPPER PORTION. RETAIN LOWER PORTION FOR YOUR RECORDS 05 794672 11.15.17 EFTA00792070
NYC - 5UBTI C‘,N•IrcItit :11 DECLARATION OF ESTIMATED UNINCORPORATED BUSINESS TAX (FOR INDIVIDUALS, ESTATES AND TRUSTS) For CALENDAR YEAR 2018 beginning and ending 2018 First name and meal ANASTASIYA Last nano Noma Caange SIROOCHENKO SOCIAL SECURITY NUMBER *** -** -9816 lemlness name SUBLIME ART LLC BUSINE96 COOE NUMBER AS PER FEDERAL HE TURN lemlness /Mien (number and 511(401 Andres* 244 FIFTH AVENUE #1590 Chart. — City and Mate NEW YORK, NY ZIP coda 10001 Cony In ritX V$/ ESTATES ANO IRVSTS ONLY. ENTER EMPLOYER IDENTIFICATION NUMBER lemlness Telephone Number Taxpayers Email Amens A Payment 1. Estimate of 2018 tax Amount included with form • Make payable to: NYC Department of Runts A. 2. Amount to be paid with this declaration (Payable to: NYC DEPARTMENT OF FINANCE) ayment Amount 63000. 65120. 63000. Signature of taxpayer Tire Date To receive proper credit, you must enter your correct Social Security Number or Employer Identification Number on your declaration and remittance. DETACH ON DOTTED LINE & MAIL UPPER PORTION. RETAIN LOWER PORTION FOR YOUR RECORDS 05 794572 11.15.17 EFTA00792071
EXTENSION GRANTED TO 10-15-18 NYC - 202 DIN'1" . . :time Estates and Trusts using an El N as their primary Identifier must use Form NYC-202E IN UNINCORPORATED BUSINESS TAX RETURN FOR INDIVIDUALS AND SINGLE-MEMBER LLCs For CALENDAR YEAR 2017 beginning First name and initial Last name ANASTASIYA SIROOCHENICO In Care Of CI Ann% — Business name SUBLIME ART LLC Business address (number and street) 244 FIFTH AVENUE #1590 City and State NEW YORK, NY Business Telephone Number Andrea Clangs — ZIP Code 10001 Country or not US) Oak bisncla ENO n NTECrunallil 01, butinth tntittl in NYC(mmtAllY) and ending 2017 TAXPAYER SEMI. ADDRESS SOCIAL SECURITY KAISER ***—** -9816 BUSINESS CODE MAIER FROM FEDERAL SCHEDULE C: 453920 -f. MWM&011en If tip purpose of the windedream Is to report a taisrai a state chafes. chock the apcmonate bow IRS change Date or Final NYS change Determination Final return • Ceased cpwabons Attach copy of your entire todetal Form MA) end statement snowing eiLscesition or business propeny. Engaged In a fully exempt unincorporated business activity Engaged in a WPM ccoarrpt unincorporated business activity Clan any 9/11/Df +elated %demi tax benefits Goo InstructiOnS) Enter 2-clwaCter special deadlier+ CHIA if OPplictiale (see instructions) SCHEDULE A Computation of Tax BEGIN MTH SCHEDULE B ON PAGE 3. COKIPLE1E ALL 0111ER SCHEDULES. IBANSPER APPLICABLE AMOUNT'S TO SCREDULE A. A. Payment I Amount being paid electronically with this return A. 1. Business income (from page 3, Schedule B, line 27) 2. Business allocation percentage from Schedule C, line 5. (If not allocating, enter 100%) 3. If line 2 is less than 100%. enter income or loss on NYC real property(see instrucbons) 4. Balance (line 1 less line 3) 5. Multiply line 4 by the business allocation percentage on line 2 6. Amount from line 3 (NYC real property income and gain not subject to allocation) (see instructions) 7. Investment Income (from page 3. Schedule B. line 26) 8. Investment allocation percentage (from page 4, Schedule D, line 2) 8. 9. Multiply line 7 by the investment allocation percentage from line 8 (see Thstructions) 10. Total before NOL deduction (sum of lines 5.6 and 9 or line 1 and line 9) (see instructions fort/no 2) 11. Deduct: NYC net operating loss deduction (from Form NYGNOLOUBTI, line 7) (see instrucUons) 12. Balance before allowance for taxpayer's services (line 10 less line 11) 13. Less: allowance for taxpayer's services • do not enter more than 20% of Noe 12 or $10,000, whichever is less (see instructions) 14. Balance before exemption (line 12 less line 13) 15. Less: exemption • S5.000 (taxpayer operating more than one business or short period taxpayer, see insttuctions) t6. Taxable income (line 14 less line 15)(see instructions) t7. Tax before business tax credit (4% of amount on line 16) 18. Less: business tax credit (select the applicable credit condition from the Business Tax Credit Computation schedule on the bottom of page 2 and enter amount) (see instructions) t9. UNINCORPORATED BUSINESS TAX (line 17 less line 18) (see instructions) 2. PayTOnt AMOWIt 1. 100 . 1642867. 00 °, 3. 4. 5. 6. 7. 1642867. 1642867. 0.0 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 1642867. 1642867. 10000. 1632867. 5000. 1627867. 65115. 65115. 794521 1 I-22.47 THIS RETURN MUST BE SIGNED. (SEE PAGE 5 FOR SIGNATURE BOX AND MAILING INSTRUCTIONS.) 20- 05 60211705 EFTA00792072
Form NYC•202 2017 Page 2 Name ANASTASIYA SIROOCHENKO SSN ***_**_9816 20a. Credits from Form NYC•114.5 (attach form) (see Instructions) 20a. 20b. Credits from Form NYC•114.6 (attach form) (see Instructions) 20b. 20c. Credits from Form NYC•114.8 (attach tarn) (see Instructions) 20c. 20d. Credits from Form NYC•114.10 (attach form) (see instructions) 20d. 20e. Credits from Fomi NYC•114.12 (attach form) (see instructions) 20e. 21. Net tax after credits (line 19 less sum of lines 20a through 20e) 21. 65115. 22. Payment of estimated Unincorporated Business Tax, including carryover credit from preceding year and payment with extension, NYC•EXT 22. 70000. 23. If line 21 is larger than line 22, enter balance due 23. 24. If line 21 is smaller than line 22, enter overpayment 24. 4885. 25a. Interest (see instructions) 25b. Additional charges (see instructions) 252. 25b. 25c. Penalty for underpayment of estimated tax (attach form NYC•221) 250. 1818. 26. Total of lines 25a, 25b and 25c 26. 27. Net overpayment (line 24 less line 26) (see Instructions) 27. 28. Amount of line 27 to be: (a) Refunded • Direct deposit • Mout dna 28c OR Paper check . 28a. (b) Credited to 2018 Estimated Tax on Fomi NYO5UBT 28b. 28c. Routing Account Number Number 29. Total remittance due (see Instructions) 30. NYC rent deducted on federal tax retum or NYC rent from Schedule C. 31. Gross receipts or sales from federal return ACCOUNT TYPE Savings 29. 30. 31. 1818. 3067. 3067. 0. 3230000. Business Tax Credit Computation 1. If the amount on page 1. line 17, is 5.3.400 or less, your credit on line 18 is the entire amount of tax on line 17. (NO TAX WILL BE DUE.) 2. If the amount on page 1. line 17. is 55.400 or over, no credit is allowed. Enter `0' on line 18. 3. If the amount on page 1, line 17, is over $3,400 but less than $5,400. your credit is computed by the following formula: amount on pg. 1, line 17 X ( $5,400 minus tax on line 17 )= $2,000 your credit Prepayments of Estimated Tax Computation PREPAYMENTS CLAIMED ON SCHEDULE A, LINE 22 DATE AMOUNT A. Payment with declaration, Form NYC•5UBTI (1) B. Payment with Notice of Estimated Tax Due (2) C. Payment with Notice of Estimated Tax Due (3) D. Payment with Notice of Estimated Tax Due (4) E. Payment with extension, Form NYOIEXT F. Overpayment credited from preceding year G. TOTAL of A. B. C. D. E. F (enter on Schedule A. line 22) 12-31-17 70000. 70000. 60221705 759522 11.22.17 05 EFTA00792073
Form NYC-202 2017 Page 3 Name ANASTASIYA SIROOCHENKO SSN ***-**-9816 SCHEDULE B Computation of Total Income Part 1 Items of business income, gain, loss or deduction 1- Net profit (or loss) from business, farming or professions as reported for federal tax purposes from federal Schedule C, GEZ or F (Form 1040) (see instructions) 2. If entering income from more than one federal Schedule C. C•l2 or F (Form 1040), check this box Enter the number of Schedules C, C•EZ or F attached: lb 3. Gain (or loss) from sale of business personal property or business real property Wadi knotal Schedus, 00! Form 4ran 3. 4. Net amount of rental or royalty income from business personal property or business real property (attach federal Schedule E) (see instructions) 4. 5. Other business income (or loss) (attach schedule) (see Instructions) 5. 6. Total federal income (or loss) (combine lines 1 through 5) 6. 7. Subtract net income or gain (or add net loss) from rental, sale or exchange of real property situated outside New York City, if included in line 3 or 4 above (attach schedule) (see Instructions) 8. Total ncome before New York City modifications (combine lines 6 and 7) 2. 7. 8. Part 2 I New York City modifications (see instructions for Schedule B. part 2) ADDITIONS 9. All income taxes and Unincorporated Business Taxes 10a. Relocation credits 10b. Expenses related to exempt income 10c. Depreciation adjustments (attach Fomt NYC-399 and/or NYC-399Z) 10d. Real estate additions (see instructions) 11. Other additions (attach schedule) (see Mstructlons) 12. Total additions (add lines 9 through 11) SUBTRACTIONS 13. All income tax and Unincorporated Business Tax refunds (included in part 1) 13. 14. Wages and salaries subject to federal jobs credit (see instructions) 14. 15. Depreciation adjustment (attach Form NYC-399 and/or NYC-399Z) 15. 16. Exempt income included in part 1 (attach schedule) 16. 17. 50% of dividends(see instruction) 17. 18. Real estate subtractions (see instructions) 18. 19. Other subtractions (attach schedule) (see instructions) 19. 20. Total subtractions (add lines 13 through 19) 20. 21. NYC modifications (combine Ines 12 and 20) 21. 70000. 22. Total income (combne lines 8 and 21) 22. 1642867. 23. Less: Charitable contributions (not to exceed 5% of line 22)(see instructions) 23. 24. Balance (line 22 less line 23) 24. 1642867. 25. Investment income • (complete lines a through g below) (see instructions) (a) Dividends from stocks held for investment 25a. (b) Interest from investment capital (nclude nonexempt governmental obligations) (Itemize on rider) 25b. (c) Net capital gain (loss) from sales or exchanges of securities held for investment 25c. (d) Income from assets included on line 3 of Schedule D 25d. (e) Add lines 25a through 25d inclusive 25e. (f) Deductions directly or indirectly attrbutable to investment income 25f. (g) Interest on bank accounts included in income reported on line 25d 25g. 26. Investment income (line 25e less line 250 (enter on page 1, Sch. A, line 7) 26. 27. BUSINESS INCOME (line 24 less line 26) (enter here and transfer amount to pg 1, Sch. A, line 1) 27. 1642867. 9. 10a. 10b. 10c. 10d. 11. 12. 1572867. 1572867. 1572867. 70000. 70000. 60231705 794531 1142-O 05 EFTA00792074
Form NYC-202 2017 Page 4 Name ANASTASIYA SIROOCHENKO SSN ***-**-9816 ALLOCATION OF BUSINESS INCOME Taxpayers who carry on business both inside and outside New York City should complete Schedule C. Parts 1.2 and 3 (below). Taxpayers who do not carry on business both inside and outside New York City should omit Schedule C. Parts 1 and 2 (below), enter 100% on Part 3 line 5 and enter 100% on Schedule A line 2. SCHEDULE CJ Complete this schedule It business is carried on both inside and outside New York City Part I List location of each place of business INSIDE New York office, public warehouse, contractor, converter. etc. . City, nature of activities at each loca ion (manufacturing, sales office, executive and number of employees, their wages salaries and duties at each location. Complete Address Rent Nature of Activities No Emoroyees Wages, Salaries, Etc. Duties I I I I Total I, Part 2 List location of each place of business UU I bilk New York City, nature of activitie at each location (manufactunng. sales office. executive office. public warehouse, contractor. converter. etc). and number of employees. their wages, salaries and duties at each location. Complete Address Rent Nature of Activities no u. Employees Wages, Salaries, Etc. Duties I 1 I I Total Part 3 I Formula Basis Allocation of Income DESCRIPTION OF ITEMS USED AS FACTORS Malaga villa or me real and tang) persona, INCOOrty d too busload; (lee Ina a. Business real property owned Ia. b. Business real property rented from others veer x a lb. e. Business tangible personal property owned 1c. d. (tintless Weide emend dalcrOnaltdirom altos bent x Id. e. Total of lines 1a • 1d le. f. Multiply Column C of line 1e by 3.5 If. 2a. ptro;‘74 1111,;irel yisZr ." ia" .""P"""""" 2a. 2b. MultietColumn C of line 2a by 3.5 2b. 3a. Owing Ma year 3a. 3b. Multiply Column C of line 3a by 93 Weighted Factor Allocation 4a. Add Column C. lines lf, 2b and 3b Olva lino la by '00 It no focal are mleas setae* is missing. divideIMO 4a by the total a a no gn:s ol :no lamas 4b. present. Enter as percentage. Round to the nearest one hundredth oi e percentage pat Business Allocation Percentage 5. Enter percentage from line 4b. Transfer to page 1, Schedule A, line 2. See instructions 5. 6. IS ANY PLACE OF BUSINESS LISTED IN PARTS 1 AND 2 LOCATED IN YOUR HOME? 7. DID YOU CLAIM A DEDUCTION FOR EXPENSES OF AN OFFICE IN YOUR HOME? COLUMN A - NEW YORK CITY COLUMN B - EVERYWHERE COLUMN C PERCENTAGE IN NEW YORK CITY (COLUMN A DIVIDED BY COLUMN B) 3b. 4b. YES YES pS NO NO SCHEDULE D I Investment Capital and Allocation and Cash Election DESCRIPTION OF INVESTMENI No ot Aares en Amount of Socurars age Av vans Llabirltin Attributable to Investment capital Percentage Not Average Value Nolan Omit:snob:no (h F Issuers elocation Value ;located to NYC Maumee E x oolurrn Fl Lb. kaftan:KW NO. • NSF RICO If PECESSAW, i 1. rams (Including Items on rapt) • lila 2. Investment allocation percentage 3. Cash - 1.0 beat Cash a Imeratant capital. " you mat include non INS IMO) 4. Investment capital. Total of tines 1E line 1G divided by line IIII. and 3E 1E, round to the nearest one hundredth of a percentage point) % illio 60241705 ATTACH FEDERAL SCHEDULE C, SCHEDULE C-EZ OR SCHEDULE F, FORM 1040 TO THIS RETURN 724532 II -29.17 05 EFTA00792075
Form NYC-202 2017 Page 5 Name ANASTASIYA SIROOCHENKO SSN ***_**_9816 SCHEDULE E If you are taking a Net Operating Loss Deduction this year, please attach Form NYC-NOLD-UBTI SCHEDULE F The following information must be entered for this return to be complete. 1. 2. 3. 4. 5. 6. Nature of business or profession: ART DEALER New York State Sales Tax ID Number: Did you file a New York City Unincorporated Business Tax Return for the following years: 2015: YES X NO 2016: YES X NO If 'NO.' state reason: Enter home address: 288 WEST 4TH ST NEW YORK NY ZIP Code: 10014 If business terminated during the current taxable year, state date terminated. (mmddly) (Attach a statement showing disposition of business property.) Has the Internal Revenue Service or the New York State Department of Taxation and Finance increased or decreased any taxable income (loss) reported in any tax period, or are you currently being audited?. YES X NO If 'YES", by whom? Internal Revenue Service State period(s): Beg.: End.: New York State Department of Taxation and Finance State period(s): Beg.: End.: um.w. 7. Has Form NYC•115 (Report of Federal/State Change in Taxable Income) been filed? Only applicable for years prior to 1/1/15. For years beginning on or after 1/1/15, file an amended return. (see entructkes) YES 8. Did you calculate a depreciation deduction by the application of the federal Accelerated Cost Recovery System (ACRS)? YES 9. Were you a participant in a 'Safe Harbor Leasing" transaction during the period covered by this return? YES 10. Does this taxpayer pay rent greater than $200,000 for any premises in NYC in the borough of Manhattan south of 96th Street for the purpose of carrying on any trade, business, profession, vocation or commercial activity? 11. If 'YES', were all required Commercial Rent Tax Returns filed? Please enter Employer Identification Number or Social Security Number which was used on the Commercial Rent Tax Return: CERTIFICATION X NO X NO X NO YES X NO YES NO I hereby certify that 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 PrCatell SOCOI Swirly Numb.; PREPARER'S P00962062 USE pPreparerses Precrw'S DAVID Chock It sell. oamployoc1 —4. ONLY skralure Primed name WEISS Data DAVID WEISS CPA, PLLC 183 MADISON AVE SUITE 803 NEW YORK, NY 10016-4403 A Firm's name (or yours, d self-employed) A Address A ZIP Code RunEngbrialmitenowitm **-***2756 MAILING INSTRUCTIONS Attach copy of federal Form 1040, Schedule C, Schedule C-EZ or Schedule F. If this is a final return, attach an entire copy of federal Form 1040. Make remittance payable to the order of NYC DEPARTMENT OF FINANCE. Payment must be made in U.S. dollars and drawn on a U.S. bank. To receive proper credit, you must enter your correct Social Security Number on your tax return and remittance. The due date for the calendar year 2017 return is on or before April 7, 20 8. For fiscal years beginning in 2017, file on or before the 15th day of the fourth month following the close of the fiscal year. ALL RETURNS EXCEPT REFUND RETURNS NYC DEPARTMENT OF FINANCE UNINCORPORATED BUSINESS TAX BOX 5564 BINGHAMTON, NY 13902-5564 REMITTANCES PAY ONLINE WITH FORM NYC-200V AT NYC.60WESERVICES OR Mail Payment and Form NYC-200V ONLY to: NYC DEPARTMENT OF FINANCE M. BOX 3933 NEW YORK. NY 10008-3933 RETURNS CLAIMING REFUNDS 'NC DEPARTMENT OF FINANCE UNINCORPORATED BUSINESS TAX BOX 5563 BINGHAMTON, NY 13902-5563 60251705 793533 11.29.17 05 EFTA00792076
NYC - 221 UNDERPAYMENT OF ESTIMATED UNINCORPORATED BUSINESS TAX ATTACH TO YOUR TAX RETURN For CALENDAR YEAR 2017 or FISCAL YEAR beginning Print or Type • Name , and ending 2017 ANASTAS I YA SIROOCHENKO SOCIAL SECURITY NUMBER ***_*._9816 OR PARTNERSHIPS. ESTATES AND TRUSTS ONLY ENTER EMPLOYER IDENNFICAMON NUMBER Computation of Underpayment I 1. 2017 tax (from NYC•202 or NYG2028N, Schedule A, line 19; NYG204, Schedule A. line 21; or NYC -2025. Schedule A, line 8) 1. 2. Credits (from NYC•202 or NYC•202EIN, Schedule A, lines 20a, 20b, 20c, 20d and 20e or NYC204, Schedule A lines 22a, 22b, 22c. 22d and 22e) 3. Line 1 less line 2 2. • 3. 4. 90% of line 3 4. 65115. 65115. 58604. Enter quarterly due dates of installments a 1- FIRST r Remo I 06-15-17 3- THIRD 4 FOURTH l 04-18-17 I 09-15-17 I 01-15-18 5, Divide amount of line 4 by the number of installments required for the year. Enter .. the result in the appropriate columns • • • 0. 6. Amount paid or credited for each period 6. 7. Overpayment of previous installment 7. 8. Total of lines 6 and 7 8. 9. Overpayment (line 8 less line 5) 9. 10. Underpayment pine 5 less line 8) 10. 14651 . 14651 . 14651 . 14651 . 70000 . 70000. 55349. 14651 . 14651 . 14651 . —> COMPUTATION CONTINUES ON PAGE 2 [Exceptions that Avoid the Underpayment Penalty otal cumulative amount paid or credited from the beginning of the taxable year through the installment dates that correspond to the 15th day of the 4th. 6th and 9th months of the taxable year and the 15th day of the first month of the succeeding taxable year AEXCEPTiOn i. , Ma wigs tir (2010 I . 5440) 1. FiRST QUARTER 2- SECOND QUARTER 3. THIRD QUARTER 4 I- DONN WORMS 0. 0. 0. 70000 . 25% or 2016 tax 1360. 50% of 20,6 fax 2720. 75% o12016 tax 4080. 100% of 2016 tax 5440. • EXCEPTION 2 - Tax on prior year's facts and law using 2017 rates (attach computation) • EXCEPTION 3 - Tax on annualized 2017 income (attach computation) • EXCEPTION 4 - Tax on 2017 income over short periods (attach computation) • EXCEPTION 5 - Tax on recurring seasonal 2017 income (attach computation) Enter 25% 01 tax Enter 5016 of tax Enter 75% of tar Enter 100/6 of la, Enter 22.50% or tax Enter 4596 of tax Enter 67.50% 0. tax WOE PCIN of tax Enter 9W5 ol bu triter 90% at tax EXCEPTION MET 60511705 Ames 11-15-17 NO NO NO N/A NYC-221 261 05 EFTA00792077
Form NYC-221 - 2017 Page 2 COMPUTATION OF PENALTY 1- FIRST 2- SECOND 1 06-15-17 3- THIRD 4. FOURTH 04-18-17 09-15-17 01-15-18 11. Enter the date of payment or the 15th day of the 4th month after the close of the taxable year, whichever is earlier 11 SEE UNDERPAYMENT OF ES 12. Number of days from due date of instalment to the date shown on line 11 13. Mentes of dayson line fl ans 4/15/2017 and been 7/1/201T 13. 14. Number of days on line 12 after 6/30/2017 and before 10/1/2017 14. 15. Number of days on line 12 after 9/3012017 and before 1/1/2018 15. 16. Number of days on line 12 after12/31/2017 and before 4/1/2018 16. 17. Number of days on line 12 after 3/31/2018 and before 7/1/2018 17. 18. Number of days on line 12 after 6/30/2018 and before 10/1/2018 18. 19. Number of days on line 12 after 9/30/2018 and before 1/1/2019 19. 20. Pemba M dayson line 12 afar 12/31/2015 and 0030f. 5/15/2019 12. 20. 21. Number of days on line 13 x 8% x amount on line 10 365 21. 22. Number of days on line 14 x 8% x amount on line 10 365 23. Number of days on line 15 x 8% x amount on line 10 365 22. TIMATED TAX WORKSHEE 23•\-- 24. Number of days on line 16 x •% x amount on line 10 365 24. 25. Number of days on line 17 x x amount co line 10 365 25. 26. Number of days on line 18 x x amount co line 10 365 26. 27. Number of days on line 19 x x amount on line 10 365 27. 28. Number of days on line 20 x'04 x amount on line 10 365 28. 29. Add IMes 21 through 28 29. 30. To complete this line, refer to the instructions for line 30 30. 196. 591. 1031. 31. Add the amounts on line 29 (or line 30, if applicable) for quarters through 4. Enter total and transfer amount to Form NYC-202 or NYC-202EIN, Schedule A, line 25c or Form NYC-204, Schedule A, line 27c (see instructions (or line 30) 31. 60521705 1818. 'For information regarding interest rates, call 311. If calling from outside of the five NYC boroughs, please call 212-NEW-YORK (212-639-9675). You may also consult the Department of Finance website at nyc.gov/finance 794482 i- I r 05 EFTA00792078
UNDERPAYMENT OF ESTIMATED TAX WORKSHEET NYC ANASTASIYA SIROOCHENKO d f miff f 9816 'Ddie 43: kLs Balance Dud a Ild-dfd0,fd :E Dat Penal:, Rate -0- 04/15/17 14651. 14651. 61 .000219178 196. 06/15/17 14651. 29302. 92 .000219178 591. 09/15/17 14651. 43953. 107 .000219178 1031. 12/31/17 70000. -26047. 01/15/18 14651. 11396. Penalty Due (Sum of Column F). 1818. • Date of estimated lax payment, withholding credit date or installment due date. 7 125 11 EFTA00792079
NYC ?c- u"." .11,11V. I NYC 579-UBTI NEW YORK CITY DEPARTMENT OF FINANCE 2017 Signature Authorization for E-Filed Unincorporated Business Tax Return for Individuals ELECTRONIC RETURN ORIGINATORS (ER0): DO NOT MAIL THIS FORM TO THE DEPARTMENT OF FINANCE. KEEP THIS FOR YOUR RECORDS. FIRST NAME AND INITIAL ANASTASIYA LAST NAME SIROOCHENKO SOCIAL SECURITY NUMBER *** - ** -9816 EMAIL ADDRESS: TYPE OF FORM: WG5UBTI _ NYGEXT NYC-202S X WG202 Financial Institution Information - must be included if electronic payment is authorized AMOUNT OF AUTHORIZED DEBIT: FINANCIAL INSTITUTION ROUTING NUMBER: FINANCIAL INSTITUTION ACCOUNT NUMBER: Part A - Declaration and authorization of Taxpayer for Forms NYC-202, NYC-202S, NYC-EXT or NYC-5UBTI Under penalty Unincorporated knowledge and electronically Internal Revenue Business Tax New York City designated financial Business Tax X I authorize as my _ As the of perjury, I declare that I am the taxpayer and that I have examined the information on its 2017 New York City electronically Business Tax return. including any accompanying schedules, attachments and statements or other report, and to the belief, the electronically filed document is true, correct and complete. The ERO has my consent to send the 2017 New filed Unincorporated Business Tax return or other report checked above to the New York City Department of Finance through Service. I authorize the ERO to enter my PIN as my signature on the 2017 New York City electronically filed Unincorporated return or other report, as indicated above or I will enter my PIN as my signature on the document indicated above. If I am Unincorporated Business Tax owed by electronic funds withdrawal. I authorize the New York City Department of Finance agents to initiate an electronic funds withdrawal from the financial institution account indicated on the Unincorporated return or other report, and I authorize the financial institution to debit the amount from that account. DAVID WEISS CPA, PLLC to enter my PIN: 49816 filed best of my York City the paying the and its above. !KO HAM NAM! signature on the 2017 Unincorporated Busness Tax return or other report. as indicated above taxpayer I will enter my PIN as my signature on the 2017,Unincorporated Business Tax return or other report, as indicated — Ar lir Signature of Taxpayer Official title Date Part B - Declaration of electronic return originator (ERO) and paid preparer Under penalty of perjury, I declare that the information unincorporated business tax return or other report with a completed 2017 New York City paper unincorporated information contained in the taxpayer's 2017 New contained in the paper return. If I am the paid preparer, filed unincorporated business tax return or other based this declaration on all information available ERO EFIN/PIN: Enter your six-digit EFIN followed DAVID WEISS CPA, PLLC contained in the abovenamed taxpayers 2017 New York City electronically filed checked above is the information furnished to me by the taxpayer. If the taxpayer furnished bushess tax return or other report signed by a paid preparer. I declare that York City electronically fled unincorporated business tax return or report is identical under penalty of perjury I declare that I have examined this 2017 New York City report, and, to the best of my knowledge and belief, the return is true, correct, and complete. to me. by your five digit PIN: 13769913349 me the to that electronically I have DAVID WEISS CPA, PLLC ERO's Signature Print Name Date DAVID WEISS Paid Preparers Signature Print Name Date PURPOSE - A completed Form NYC-579-UBTI provides documentation that an ERO has been authorized to electronically file the Unincorporated Business Tax return or other report. The taxpayer may designate the ERO to electronically sign the return or other report by entering the taxpayer's personal identification number (PIN). The form also authorizes payment of tax due on an electronically submitted return or report by an automatic clearing house (ACH) debit from a designated checking or savings account of the taxpayer. You cannot revoke this authorization. GENERAL INSTRUCTIONS Part A - Part A must be completed by the taxpayer before the ERO transmits the electronically filed Form NYC-202 (Unincorporated Business Tax Return for Individuals and Single Member LLC's); WC-202S (Unincorporated Business Tax Return for Individuals); WC-Da (Application for &Month Extension to File Business Income Tax Return); or NYGSUBTI (Declaration of Estimated Unincorporated Business Tax for Individuals, Estates and Trusts). EROs/paid preparers must complete Past B prior to transmitting electronically filed unincorporated business tax returns or reports (Forms NYG202, NYC-202S, WOUT or WG5UBTI). Both the paid preparer and the ERO are required to sign Part B. However, if an individual performs as both the paid preparer and the ERO, he or she is only required to sign as the paid preparer. It is not necessary to include the ERO signature in this case. Do not mail Form NYC-679•UBTI to the Department of Finance. The EROs/paid preparers must keep the completed Form NYC-579-LIB11 for three years from the due date of the return or report or the date the return or report was filed, whichever is later, and must present It to the Department of Finance upon request. 794911 11-15-17 NYC-579-U811 mu 06 EFTA00792080










