EFTA00300258.pdf

Print Form FORM 720 V.I. (REV. 03/2012) Government of the U. S. Virgin Islands Gross Receipts Monthly Tax Return BUREAU OF INTERNAL REVENUE (Use for filing receipts of more than $225.000 per year.) Employer Identification Number (EIN) Please Print or TAX MONTH Type Clearly 0 5 Social Security Number (SSN) Indicate Firm Type: Sole Proprietor Accounting Method: v CASH 20 1 5 Partnership ACCRUAL EXEMPTION CODE H M V Corporation (SEE REVERSE ) I.) GROSS RECEIPTS t. 567,525.00 2.) (minus) EXEMPTION (ex. Standard SS,000 or 59,000. Fishermen. EDC, lottery 2. commission. affordable housing. reverse osmosis. etc. -567,525.00 J 3.) TAXABLE RECEIPTS (line I minus line?) 3. 0.00 4.) TAX DUE (multiply line 3 by the narrate of 0.05 ors%) 4. 0.00 5.) UP FRONT GROSS RECEIPTS TAX WITHHELD 5. 6.) ADJUSTED TAX DUE (line 4 minus lines) 6. 0.00 7.) PENALTY (ifpayment is late, multiply line 6 by .05 or 5%per month, but not to 7. exceed 2.5%) R.) INTEREST (ifpayment is late, multiply line 6 by .01 or 1%per month) & 9.) (minus) CREDITS (overpayments) 9. F-- 10.) TOTAL AMOUNT DUE (add line 6, 7.8 minus line 9) 10. 0.00 Name 11 ) Indicate Principal Business Southern Trust Company, Inc. Activity Code: H 4 I 6 plirq D/B/A (SEE REVERSE ) 12.) Telephone Number Mailing Address 6100 Red Hook Quarter, B3 PLEASE REMIT BY DUE DATE TO: City State Zip Code BUREAU OF INTERNAL REVENUE Sr. THOMAS, U.S.V.I. 00802 St. Thomas V I 00802-1348 St CROIX, U.S.V.I. 00820 I DECLARE UNDER PENALTY OF PERJURY THAT THIS RETURN HAS BEEN EXAMINED BY ME AND TO THE BEST OF MY KNOWLEDGE AND BELIEF IT IS TRUE, CORRECT AND COMPLETE, PURSUANT TO TITLE 33 VIC SECTIONS 42 & 43. Print Name: Jeffrey Epstein Title: President (PRESIDENT, OWNER,Ell I Signature: Date: 06/29/15 FORM 720V1 (31x)12) EFTA00300258