Annual Report (Limited Liability Company)

ANNUAL REPORT AND COMPUTATION OF FILING FEE PURSUANT TO TITLE 13, ACT NO.6204. CHAPTER 15 SUBCHAPTER II, SEC. 1211 LIMITED LIABILITY COMPANY ­ DOMESTIC/FOREIGN (THIS REPORT IS DUE ON OR BEFORE JUNE 30TH OF EACH YEAR) Date of report: .................................................... This Report is for period ending: ............................. (FINANCIAL STATEMENT FILED SHOULD BE FOR THE CALENDER 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: _______________________________________________________________________ 3.) (A) Name of agent for service of process in the Virgin islands: ______________________________________________________ (B) Physical address of agent: _________________________________________________________________________________ (C) Mailing address of principal office: ________________________________________________________________________ (D) Physical address of principal office: _________________________________________________________________________ 4.) (A) NAME OF MANAGERS ______________________________________ ______________________________________ ______________________________________ (B) ADDRESS 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 (D) Capital withdrawn since last report : ........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 CALCULATED ACCORDING TO GAAP) $__________________________________ $__________________________________ $__________________________________ $__________________________________ $__________________________________ $__________________________________ 6.) COMPUTATION OF FILING FEE: Rate of $1.50 per M (fractions of a thousand disregard) on highest Total paid-in capital as reported on line 5(f) above FEE DUE: (Above figure or $300.00, which ever is greater)......$ _______ $________________________________________ 7.) PENALTY AND INTERESTFOR LATE PAYMENT: 20% of FEE for failure to pay by June 30th ......$ ______ 1.5% (compounded annually) for each month or part thereof by which payment is delayed beyond June 30th....$_____ TOTAL PENALTY AND INTEREST 8.) Total fee due and forwarded herewith (sum of (6), (7), and(8) $________________________________ $_________________________________ $_________________________________ (ATTACHED CHECK PAYABLE TO DEPARTNMENT OF FINANCE AND MAIL TO THE OFFICE OF THE LIEUTENANT GOVERNOR. DIVISION OF CORPORATION AND TRADEMARK, KONGENS GADE #18, ST. THOMAS, USVI 00802 OR 1131 KING STREET, SUITE#101 C'STED, ST. CROIX USVI 00820) _____________________________________________ MEMBER _________________________________________ DATE American LegalNet, Inc. www.FormsWorkflow.com