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 Employer Identification Number (EIN) Please Print or TAX MONTH Type Clearly 01/5 Social Security Number (SSN) Indicate Firm Type: Accounting Method: y) 0 Sole Proprietor v|| CASH Partnership ACCRUAL EXEMPTION CODE 0) 2 Corporation (SEE REVERSE ) 1.) GROSS RECEIPTS 567,525.00 2.) (minus) EXEMPTION (ex. Standard $5,000 o $9,000, Fishermen, EDC, lottery = x commissions, affordable housing, reverse osmosis, ete -567,525.00 3.) TAXABLE RECEIPTS line J minus line 2) 3. 0.00 4.) TAX DUE (multipty line 3 by the tax rate of 0.05 or 5%) 4. 0.00 5.) UP FRONT GROSS RECEIPTS TAX WITHHELD 5. 6.) ADJUSTED TAX DUE {line 4 minus tine 5) 6. 0.00 7.) PENALTY | (if payment is late, multiply line 6 by 05 or 5% per month, but not to 7. exceed 25%) 8.) INTEREST (if payment is late, multiply line 6 by 01 or 1% per month) 9.) (minus) CREDITS over payments) 10.) TOTAL AMOUNT DUE (add line 6, 7, 8 minus line 9) 0.00 Name 11.) Indicate Principal Business Activity Code: 5), 4) 1)/6)>1)/0 Southern Trust Company, Inc. D/BIA (SEE REVERSE ) 12.) Telephone Number PLEASE REMIT BY DUE DATE TO: BUREAU OF INTERNAL REVENUE ST. THOMAS, U.S.V.I. 00802 ST. CROIX, U.S.V.1. 00820 Mailing Address 6100 Red Hook Quarter, B3 City State Zip Code St. Thomas Vii 00802-1348 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, ETC.) Signature: Date: 06/29/15 FORM 720VI (3/2012) EFTA00300258