| CAPITAL STOCK AUTHORIZED ON LAST FILED REPORT | 10,000 shares $0.01 per value |
| CAPITAL STOCK AUTHORIZED ON THIS DATE | 10,000 shares $0.01 per value |
| SECTION 3 - PAID-IN CAPITAL STOCK USED IN CONDUCTING BUSINESS |
| A. AS SHOWN ON LAST FILED REPORT | $1,000 |
| B. ADDITIONAL CAPITAL PAID SINCE LAST REPORT | $1,000 |
| C. SUM OF 'A' AND 'B' ABOVE | $1,000 |
| D. PAID-IN CAPITAL WITHDRAWN SINCE LAST REPORT | $1,000 |
| E. PAID-IN CAPITAL STOCK AT DATE OF THIS REPORT | $1,000 |
| F. HIGHEST TOTAL PAID-IN CAPITAL STOCK DURING REPORTING PERIOD | $1,000 |
| SECTION 4 - COMPUTATION OF TAX |
| A. AT RATE OF $1.50 PER THOUSAND (PLEASE ROUND DOWN TO THE NEAREST THOUSAND)ON HIGHEST TOTAL PAID-IN CAPITAL STOCK AS REPORTED ON LINE 3F ABOVE | $1,000 |
| B. TAX DUE (4A OR $150.00 (WHICHEVER IS GREATER)) | $1,000 |
| SECTION 5 - PENALTY AND INTEREST FOR LATE PAYMENT |
| A. PENALTY - 20% OR $50.00 (WHICHEVER IS GREATER) OF 4B | R # 2286124
# 150.00
C # 1006 |
| B. INTEREST - 1% COMPOUNDED ANNUALLY FOR EACH MONTH,OR PART THEREOF, BY WHICH PAYMENT IS DELAYED BEYONDTHE JUNE 30th DEADLINE |
| C. TOTAL PENALTY AND INTEREST |
SECTION 6 - TOTAL DUE (TAXES, PENALTY, INTEREST)
SUM OF 4B AND 5C
$$\$150.00$$
I DECLARE, UNDER PENALTY OF PERJURY, UNDER THE LAWS OF THE UNITED STATES VIRGIN ISLANDS, THAT ALL STATEMENTS CONTAINED IN THIS APPLICATION, AND ANY ACCOMPANYING DOCUMENTS ARE TRUE AND CORRECT, WITH FULL KNOWLEDGE THAT ALL STATEMENTS MADE IN THIS APPLICATION ARE SUBJECT TO INVESTIGATION AND THAT ANY PALSE OR DISHONEST ANSWER TO ANY QUESTION MAY BE GROUNDS FOR DEMILOR OR SUBSEQUENT REVOCATION OF REGISTRATION.
USAO 000821
| EFTA_00018731 |
| :--- | :--- |
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