FBAR 2016REPORT of FOREIGN BANK Accountsnew FILING DEADLINE: APRIL 18, 2017

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877- 4 TAXGEEKS (877-482-9433)

FBAR 2016REPORT OF FOREIGN BANK ACCOUNTSnew FILING DEADLINE: APRIL 18, 2017

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filer Information

Last Name: / First Name: / Middle Initial:
Date of birth: / SSN: / Phone:
Current address:
City: / State: / ZIP Code:
Do you have a financial interest in 25 or more financial accounts? _____Yes _____ No

INFORMATION ON FINANCIAL ACCOUNT(S) OWNED SEPARATELY – account 1

Maximum value of account during calendar year reported :
Type of Account (Please mark ‘x’) : ___ Bank ____Securities ____ Other (Specify)______
Name of Financial Institution in which account is held:
Account Number: / Mailing Address (Number, Street, Suite Number) of financial institution in which account is held:
City: / State: / ZIP Code: / Country:

If you have more than one Financial Accounts – Owned separately, please continue to fill the below form. If you have joint accounts, please enter the details in the JOINT ACCOUNT section below.

INFORMATION ON FINANCIAL ACCOUNT(S) OWNED SEPARATELY – account 2

Maximum value of account during calendar year reported :
Type of Account (Please mark ‘x’) : ___ Bank ____Securities ____ Other (Specify)______
Name of Financial Institution in which account is held:
Account Number: / Mailing Address (Number, Street, Suite Number) of financial institution in which account is held:
City: / State: / ZIP Code: / Country:

INFORMATION ON FINANCIAL ACCOUNT(S) OWNED SEPARATELY – account 3

Maximum value of account during calendar year reported :
Type of Account (Please mark ‘x’) : ___ Bank ____Securities ____ Other (Specify)______
Name of Financial Institution in which account is held:
Account Number: / Mailing Address (Number, Street, Suite Number) of financial institution in which account is held:
City: / State: / ZIP Code: / Country:

INFORMATION ON FINANCIAL ACCOUNT(S) OWNED SEPARATELY – account 4

Maximum value of account during calendar year reported :
Type of Account (Please mark ‘x’) : ___ Bank ____Securities ____ Other (Specify)______
Name of Financial Institution in which account is held:
Account Number: / Mailing Address (Number, Street, Suite Number) of financial institution in which account is held:
City: / State: / ZIP Code: / Country:

INFORMATION ON FINANCIAL ACCOUNT(S) OWNED SEPARATELY – account 5

Maximum value of account during calendar year reported :
Type of Account (Please mark ‘x’) : ___ Bank ____Securities ____ Other (Specify)______
Name of Financial Institution in which account is held:
Account Number: / Mailing Address (Number, Street, Suite Number) of financial institution in which account is held:
City: / State: / ZIP Code: / Country:

Information on Financial Account(s) Owned Jointly

INFORMATION ON FINANCIAL ACCOUNT(S) OWNED Jointly – account 1

Maximum value of account during calendar year reported :
Type of Account (Please mark ‘x’) : ___ Bank ____Securities ____ Other (Specify)______
Name of Financial Institution in which account is held:
Account Number: / Mailing Address (Number, Street, Suite Number) of financial institution in which account is held:
City:
/ State:
/ ZIP Code:
/ Country:
Number of joint owners for this account: (DO NOT INCLUDE YOURSELF)
/ Taxpayer Identification Number (SSN) of principal joint owner, if known. (If joint owner doesn’t have SSN, then please leave it blank)
Last Name: / First Name: / Middle Initial:
Address (Number, Street, Suite or Apartment) of principal joint owner, if known:
City:
/ State:
/ ZIP Code:
/ Country:

INFORMATION ON FINANCIAL ACCOUNT(S) OWNED Jointly – account 2

Maximum value of account during calendar year reported :
Type of Account (Please mark ‘x’) : ___ Bank ____Securities ____ Other (Specify)______
Name of Financial Institution in which account is held:
Account Number: / Mailing Address (Number, Street, Suite Number) of financial institution in which account is held:
City:
/ State:
/ ZIP Code:
/ Country:
Number of joint owners for this account: (DO NOT INCLUDE YOURSELF)
/ Taxpayer Identification Number (SSN) of principal joint owner, if known. (If joint owner doesn’t have SSN, then please leave it blank)
Last Name: / First Name: / Middle Initial:
Address (Number, Street, Suite or Apartment) of principal joint owner, if known:
City:
/ State:
/ ZIP Code:
/ Country:

INFORMATION ON FINANCIAL ACCOUNT(S) OWNED Jointly – account 3

Maximum value of account during calendar year reported :
Type of Account (Please mark ‘x’) : ___ Bank ____Securities ____ Other (Specify)______
Name of Financial Institution in which account is held:
Account Number: / Mailing Address (Number, Street, Suite Number) of financial institution in which account is held:
City:
/ State:
/ ZIP Code:
/ Country:
Number of joint owners for this account: (DO NOT INCLUDE YOURSELF)
/ Taxpayer Identification Number (SSN) of principal joint owner, if known. (If joint owner doesn’t have SSN, then please leave it blank)
Last Name: / First Name: / Middle Initial:
Address (Number, Street, Suite or Apartment) of principal joint owner, if known:
City:
/ State:
/ ZIP Code:
/ Country: