enalty (unless box B.C. or D applies). LHA For Paperwork Reduction Act Notice, see separate Instructions. Form 2210 (2014) 412501 12-23-14 8.1 SIROOCHENKO 2014.03000 SIROOCHENKO, ANASTASIYA SIROOCH1 EFTA00791944 Form2210(2M4) ANASTASIYA SIROOCHENKO Regular Method (See the instructions if you aro f

YYY In SSNATIN a Type' Passport IMI Foreign TIN Other ON b Number c 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.) 10 City NEW YORK 11 State NY 1

7 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