Page 6 of 6 IT-201-X (2014)

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 K 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 K S corporation K 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 the final federal determination (Explain) 07-23-2018 85 Do you concede the federal audit changes? Of No, exposit below.) Yes El No 1-1 88 list federal changes Sea SCH Cl — TRAVEL 86b SCH Cl - GROSS RECEIPTS OR SALES 88c SE AGI ADJUSTMENT 86d ITERMIZED DEDUCTIONS ese EXEMPTIONS 87 Net federal changes increase or decrease) 88 Federal taxable income (mark an X in one box) Per retum On Previously **stied 1:1 89 Corrected federal taxable income 90 Federal credits disallowed Earned income credit I I Amount disallowed quad care credit n Amount disallowed 91 Federal penalties assessed 91a Fraud K 91b Negiigence 88a 43,495 00 ea 50,000 00 sec -1,252 oo No 1,545 00 88e 1 , 659 00 87 95,447 co m 191,891m 89 287,33800 91c Other (explain below) ACCURACY- I RC 6662 Third-party Print designee's name designs.? DAVID WEISS Yea M No n Emai: V Paid preparer must complete (see Inset) V INS imemmimme DAVID WEISS PrepernesNY1PRIN Designee's phone number 212-695—5771 Personal identification number (PIN) 13349 V Ta:qsayer(s) must sign here V You; easy.. Fruit. mire W "it WIWWWW DAVID WEISS CPA, PLLC mem 183 MADISON AVE SUITE 803 See instructions for where to mail your return. vecipoommlee ART DEALER liewnWeewalinoWOMMDMWOnnenren" Daytime plea number E 361006141019 iii 111111 460206 EFTA00792611