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signature: Date: Print name: Paid preparer's signature: Date: Print name: RICHARD A. FERNANDES, C. P.A. TR•579•PT (9/11) IN NYPADWIL 1210841 EFTA00284491 New York Slate New York State ... signature: Date: Print name: Paid preparer's signature: Date: Print name: RICHARD A. FERNANDES, TR•579•PT (9/11) IN NYPADWIL 1210841 EFTA00284492 Nye 574_uB,.. 'Cl. 11 rCRK CITY ... EFIN followed by your five digit PIN ERO's Signature Enter Name Date RICHARD A. FERNANDES, C.P.A. Paid Preparers Signalise Enter !brie Date PURPOSE - A completed Form NYC-579.LIBTP provides documentation