EFTA00573434.pdf

From: Richard Kahn To: ICatyna Shuliak Subject: Date: Mon, 16 Nov 2015 14:46:15 +0000 Summary of your information Please review the information you are about to submit. If any of the information below is incorrect, you will need to start a new application. Click the "Submit" button at the bottom of the page to receive your EIN. Organization Type: LLC LLC Information Legal name: County: State/Territory: Start date: State/Territory where articles of organization are (or will be) filed: Addresses Physical Location: Phone Number: Responsible Party Name: SSN/ITIN: LSJ DENTAL LLC UNITES STATES VI DECEMBER 2015 VI 6100 RED HOOK QUARTER B3 ST THOMAS VI 00802 KARYNA SHULIAK SOLE MBR XXX-XX Principal Business Activity What your business/organization does: HEALTH CARE Principal products/services: DENTIST Additional LLC Information Owns a 55,000 pounds or greater highway motor vehicle: NO EFTA00573434 Involves gambling/wagering: NO Involves alcohol, tobacco or firearms: NO Files Form 720 (Quarterly Federal Excise Tax Return): NO Has employees who receive Forms W- NO 2: Reason for Applying: STARTED A NEW BUSINESS We strongly recommend you print this summary page for your records as this will be your only copy of the application. You will not be able to return to this page after you click the "Submit" button. EFTA00573435