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GOVERNMENT OF cg? eden

THE VIRGIN ISLANDS OF THE UNITED STATES gates que

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VIRGIN ISLANDS BUREAU OF INTERNAL REVERS



(DPNR FORM L&WD-6) |

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 Coastal Zone Management Permit from the Virgin Islands Department of Planning and Natural Resources pursuant

to Act 5270, amending Sections 910 (a)(2) and 911 (d)(2) of the Coastal Zone Management Act (Title 12, Chapter 21, Virgin

Islands Code). The applicant authorizes the Bureau of Internal Revenue to disclose any taxpayer information necessary to

process this application to the Virgin Islands Department of Planning and Natural Resources, who may make such further

disclosures as are necessary to carry out the requirements of the Coastal Zone Management Act, as amended.



Name: ‘Re herd M. Keene



Business Name: Me Ca Preis p+ tar Bay, LLC

EINTIN: 66-098 190%



SSN: Me sp 4594



Please Indicate: |



*Corporation Type of Business: Renter |



*Partnership



Individual Please circle forms that you use: 1120, 1120s,

| {.C_ Other 1065,1040, 941 VI, 722 VI, 720, 720 VI, 720



BVI, 50VI, other (list)



Date Business Started: Juone 2 Pw 2\



Person Representing Applicant: Position: YWlawen a aie

Signature: ob ALY VM & (Aree ‘ u ze



- oe. [s fis

Mailing Address: Vim W ila ESL 274 /



Date: T/) 20 24 elephone Number: RQ -3 al ~) 4 1%



Reply to: 9601 Estate Thomas, St. Thomas VI 00802 or 4008 Estate Diamond, St. Croix VI 00820



* Partnerships and/or Corporations must list partners/ corporate officers, social security

numbers and addresses on a seperate sheet and attach it to this application.