Tax Clearance Application
GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES ae | VIRGIN ISLANDS BUREAU OF INTERNAL REVENUE 6115 Estate Smith Bay - Suite 225 4008 Estate Diamond Plot 7B St. Thomas VI 00802 Christiansted VI 00820-4421 Phone: (340) 715-1040 Phone: (340) 773-1040 Fax: (340) 714-9341 Fax: (340) 773-1006 APPLICATION FOR TAX FILING AND PAYMENT STATUS REPORT The applicant identified below hereby requests a letter certifying his or her tax filing and payment status for the purpose of receiving a new or renewal license from the Agency requiring the clearance letter. The applicant authorizes the Virgin Islands Bureau of Internal Revenue to disclose any taxpayer information related to this application to the below listed Agency, who may make such further disclosures as are necessary to the relevant agency as required by the appropriate law. 1. Name: i 14 sos 2. Tax Identification Number: 3. Type of Business: | — = Eres 5. Please Indicate: [_] New License [_] License Renewal 6. Do you have employees? [_] Yes []No 7. …
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GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES ae | VIRGIN ISLANDS BUREAU OF INTERNAL REVENUE 6115 Estate Smith Bay - Suite 225 4008 Estate Diamond Plot 7B St. Thomas VI 00802 Christiansted VI 00820-4421 Phone: (340) 715-1040 Phone: (340) 773-1040 Fax: (340) 714-9341 Fax: (340) 773-1006 APPLICATION FOR TAX FILING AND PAYMENT STATUS REPORT The applicant identified below hereby requests a letter certifying his or her tax filing and payment status for the purpose of receiving a new or renewal license from the Agency requiring the clearance letter. The applicant authorizes the Virgin Islands Bureau of Internal Revenue to disclose any taxpayer information related to this application to the below listed Agency, who may make such further disclosures as are necessary to the relevant agency as required by the appropriate law. 1. Name: i 14 sos 2. Tax Identification Number: 3. Type of Business: | — = Eres 5. Please Indicate: [_] New License [_] License Renewal 6. Do you have employees? [_] Yes []No 7. Please indicate forms that you use: [[]1040/8689; [_]1065; (1120; (J941v1; (1720V1; [1720B; [}722V1; [_Jother (please list) 8. Date Business Started: License Expiration Date: 9. Mailing Address (Required): — 10. Physical Address: 11. Contact Person (Please Print): _ = 12. Signature: 13. Date: Contact Number (Required): REPLY TO THE ADDRESS OF THE RESPECTIVE DISTRICT LISTED ABOVE. See Back Of Form For Instructions FORM LIC 1 (REV 07/2012)