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THE GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES OFFICE OF THE LIEUTENEANT GOVERNOR DIVISION OF CORPORATIONS AND TRADEMARKS TEL. (340) 776-8515 ♦ FAX (340) 776-4612 5049 Kongens Gade, St. Thomas, VI 00802-6487 ANNUAL REPORT AND COMPUTATION OF FILING FEE PURSUANT TO TITLE 13, ACT NO. 6204, CHPTR. 15, SUBCHPTR II, SEC. 1211 LIMITED LIABILITY COMPANY - DOMESTIC/FOREIGN (THIS REPORT IS DUE ON OR BEFORE JUNE 30TH OF EACH YEAR) EMPLOYER I.D. NO. Date of Report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . …………………………….. NATURE OF BUSINESS ………………………………………………………………… This Report is for the Period Ending . . . . . . . . . . . . . . . . . . . . . . (Financial Statements filed should be for the calendar year ended before June 30th of the current year.) 1) (a) Name of Limited Liability Company_____________________________________________________________________________________ (b) State or Country where organized_______________________________________________________________________________________ 2) (a) Mailing address of designated office______________________________________________________________________________________ (b) Physical address of designated office_____________________________________________________________________________________ (c) Name of Agent for service of process in the Virgin Islands___________________________________________________________________ (d) Physical address of Agent______________________________________________________________________________________________ 3) Mailing address of Principal office_______________________________________________________________________________________ Physical address of Principal office ______________________________________________________________________________________ 4) (a) Names of Managers (b) Addresses of Managers ____________________________________________ ______________________________________________________________ ____________________________________________ ______________________________________________________________ ____________________________________________ ______________________________________________________________ ____________________________________________ ______________________________________________________________ 5) AMOUNT OF CAPITAL* USED IN CONDUCTING BUSINESS IN THE VIRGIN ISLANDS (a) As shown on last report……………………………………………………. $___________________________________ (b) Additional Capital since last report……………………………………….. $___________________________________ (c) Sum of (a) and (b)………………………………………………………….. $___________________________________ (d) Capital withdrawn since last report……………………………………… $___________________________________ (e) Total Capital at date of this report……………………………………….. $___________________________________ (f) Highest Capital during REPORTING PERIOD………………………… $___________________________________ *CAPITAL (Capital Calculated according to GAAP) 6) COMPUTATION OF FILING FEE: Rate of $1.50 per M (fractions of a thousand disregarded) on highest total paid-in capital as reported on Line 5 (f) above $__________ FEE DUE: (Above figure or $300.00, whichever is greater)……………….. $__________________________________ 7) PENALTY FOR LATE PAYMENT: 20% of FEE or $50.00 whichever is greater for failure to pay by June 30th …………………. $__________ 8) INTEREST 1.5% (compounded annually) for each month or part thereof by which payment is delayed beyond June 30th……………………………………….. $__________ TOTAL PENALTY AND INTEREST $___________________________________ 9) TOTAL FEE DUE AND FORWARDED HERWITH (Sum of (6), (7), and (8)). $ (Attach check payable to the Government of the Virgin Islands and mail to Office of the Lieutenant Governor, Division of Corporations and Trademarks, 5049 Kongens Gade, St. Thomas, USVI 00802-6487) Certified Correct _____________________________________________________ _____________________________________________ Member Date INSTRUCTIONS FOR THE REPORT OF CORPORATION FRANCHISE TAX DUE DOMESTIC/FOREIGN LIMITED LIABILITY COMPANIES 1) (a) NAME OF LIMITED LIABILITY COMPANY: Indicate the full legal name of the limited liability company as it appears on the Articles of Organization or the Application for a Certificate of Authority. (b) STATE OR COUNTRY: Indicate the state or country where the limited liability company was organized. 2) (a) MAILING ADDRESS: Indicate the mailing address of the designated office. (b) PHYSICAL ADDRESS: Indicate the physical address of the designated office. (c) NAME OF AGENT: Indicate the name of the agent listed within the Articles of Organization or the Application for a Certificate of Authority for service of process in the U.S. Virgin Islands. (d) AGENT’S PHYSICAL ADDRESS: Indicate the physical address if the named agent for service of process. 3) MAILING ADDRESS OF PRINCIPAL OFFICE: Indicate the mailing address of the principal office. PHYSICAL ADDRESS OF PRINCIPAL OFFICE: Indicate the physical address of the principal office. 4) (a) NAMES OF MANAGERS: Indicate the name of all managers (b) ADDRESSES OF MANAGERS: Indicate the addresses of all named managers. Any amendments to the Articles of Organization should be filed with the Office of the Lieutenant Governor, Division of Corporation and Trademarks. 5) AMOUNT OF CAPITAL USED IN CONDUCTING BUSINESS IN THE U.S. VIRGIN ISLANDS: The amount of capital the limited liability company shall commence business with is found within your Articles of Organization or Application for a Certificate of Authority. (a) Indicate the amount of capital as of your last report. (b) Indicate the amount of capital as of the date of this report. (c) Add lines 5(a) and 5(b). Enter the sum on this line. (d) Indicate any withdrawal of capital since the last report. (e) Subtract lines 5(d) and 5(c). This amount should equal amounts shown on the balance sheet filed with the Annual Report required in accordance with Title 13 V.I.C., Section 1211. (f) Indicate the highest amount of Capital during the reporting period. 6) COMPUTATION OF TAX. Multiply the amount on line 5(f) by 0.0015. (The tax due is calculated at a rate of $1.50 (one dollar and fifty cents) for each $1,000.00 (one thousand dollars) of capital on line 5(f). Fractions of thousands may be disregarded.) The tax due is the amount on line 4(a) or $300.00 (three hundred dollars) whichever is greater. 7) PENALTY FOR LATE PAYMENT: Payment is due by June 30th and if it is late, penalties and interest apply. The penalty for late payment is equal to 20% (twenty percent) of the fee due on Line 6. 8) INTEREST FOR LATE PAYMENT: The interest is at a rate of 1.5% (one and a half percent) of the Line 6 compounded annually per month is due for each month or part thereof that the payment is delayed beyond June 30th. 9) TOTAL FEE DUE AND FORWARDED HEREWITH: Sum lines 6,7 and 8 for the total amount of the fee, penalty and interest due. Make you checks payable to the Government of the Virgin Islands, attach it to the REPORT and return both to the Office of the Lieutenant Governor, Division of Corporation and Trademarks, 5049 Kongens Gade, St. Thomas, U.S. Virgin Islands 00802-6487. AVOID PENALTIES AND INTEREST BY FILING AND PAYING BY JUNE 30TH. Revised