EFTA00792611.pdf

Page 6 of 6 IT-201-X (2014) Your social security number 83 Reason(s) for amending your return (mark an X in ail applicable boxes; see instructions) 83a Federal audit change (complete Imes 84 through 91 below) 83b Worthless stock/secuntes 83c Claim of right 83d Wages 83e %Mary 831 Court rube(' 83g Workers' compensation 83h Treaties/visa 83i Tax shelter transaction 83j Credit claim Protective claim (See Sedittaienfd 831 Net operating loss (see instructiicat Mark an X in the tax ❑ and enter the year of the loss 83m Other. Mark an X in the box Lj and explain: 83n To report adjustments to partnership or S corporation income, gain, toss or deduction, provide the fotlowing information: Partnership ❑ S corporation ❑ Name of partnership or S corporation identifying number Principal business activity Address of partnership or S corporation If you marked an X in box 83a above, you must complete lines 84 through 91 below. All others may skip lines 84 through e 91 and go directly to the Third-party designee question. You must sign your amended return below. 84 Enter the date (mmddyyyy) of 85 Do you concede the federal audit the final federal determination 07-23-2018 changes? Of No, exposit below.) Yes El No 1-1 (Explain) 88 list federal changes Sea SCH Cl — TRAVEL 88a 43,495 00 86b SCH Cl - GROSS RECEIPTS OR SALES ea 50,000 00 88c SE AGI ADJUSTMENT sec -1,252 oo 86d ITERMIZED DEDUCTIONS No 1,545 00 ese EXEMPTIONS 88e 1 , 659 00 87 Net federal changes increase or decrease) 87 95,447 co 88 Federal taxable income (mark an X in one box) Per retum On Previously **stied 1:1 m 191,891m 89 Corrected federal taxable income 89 287,33800 90 Federal credits disallowed Earned income credit I I Amount disallowed quad care credit n Amount disallowed 91 Federal penalties assessed 91a Fraud ❑ 91b Negiigence 91c Other (explain below) ACCURACY- I RC 6662 Third-party Print designee's name Designee's phone number Personal identification designs.? number (PIN) DAVID WEISS 212-695—5771 Yea M No n Emai: 13349 V Paid preparer must complete (see Inset) V INS V Ta:qsayer(s) must sign here V imemmimme PrepernesNY1PRIN You; easy.. DAVID WEISS Fruit. mire W "it WIWWWW vecipoommlee DAVID WEISS CPA, PLLC ART DEALER mem liewnWeewalinoWOMMDMWOnnenren" 183 MADISON AVE SUITE 803 Daytime plea number See instructions for where to mail your return. E iii111111 361006141019 460206 EFTA00792611