*PLEASE FAx BACKTO 855-330-1010* ,*ss-4 ldentlflcationNumbel ADD|icatlonfol EmDlover part'.€hip., Eusb. $ttt chmr6s, by omploy€F,coDdntion3, l lF6rl.€ 'dovemm;it airqit€6, hdlan tribd €inltbs, @ttth indiviiul., and oth*) dre latest informdllon. td |[3trucdon. and > & b w.h&govlFotrnsg hstuctions lor esch flne > (ep a oopyrd your @ord& sharcfor the nsedsLLC nare ol bushes (il difidenl hom nme on liE 1) Mailinq add6s (@m, aPl., sdlle rc- 4d str€e! or /t 30 N GouldSt Ste R o sheridan, WY82801 Shendan,WY 82801 7a Nane olEpondbl€ Party ls this appli@tjon tor a llmited liability @mpdy (LLC) (oratoeisnequivd€r$? & 9a tf 8a is "Y6s,' wd ihe LLC ENo trv* in fie Un(€d $al€s? 'Y6," s TyF6ol stity (ch€ckonlyore box).Cauuon.It Sais (ssN) E soreprcpdetor PadreBhip E E ColpoEtion (dier lm number to b€ nled) E P6Fond s€rvice .orpoElion E c1urch or church-dnlrolled orgd zalion tho hstrucioN E E E E E E E Oths nonp.olltdqaniation (specr9 > 0b Oth€r lsFciM > Padnsship tlE slele orroerSn cournry (F ll a cdpoElon. lft appli€ble) wn@ lmPdated lO FBon ror aFpltng (ch4k onryore box) E $aned n€w buslB {specity l}pe) > LLC E Hi€d ffidoyees (ch€k th€ box and * line 13.) E Complia@ wilh IFS wnhholdlng regulatlons tt l3 gb ll 8: b ry€s,' enier the numbs oi > 3 LLCMbqs. El n E ! E tor tho con6ct box to chsk Estate{ssN of de.eded) Pr4 admhlsbator(nf0 lrust (rlN ot sErnod M rhsry/l,lariomlGuad E stareltetsovffot Fam* @peEuw E Fedelalgovmment FEMrc E hdranliib.lg.vmmeirs/4t€rFis Bdkins purposo(sp€civ purFs6) > atlon(speity Ew tpe) > CnaneEdVpe ot organlu Plrcnasedqohg budn$ cEated a trusr(sPeciryty!e) > cleated a p*ion plan(sp€cirytype)> Dale buslmss sldled or acaulrcd (month, day, yed. S* InslruclioN. 11t1712021 High.st numbd oi ffpLoy€65 qpei€d ln tha n€xt 12 monthsFrn6r -0- if none) It no *p oyc exp€cted. sklP llne 14. olGing monlh ot ddrnlng lax lisbrl'ryto be $1,00Oor ll you *pel ydr sdoylBt rs h a tull clendar y€ar €nd wdt lo iile Fom 944 annMllv lnsl€d of Fo.ms 941 q@rtdly. ctFck hqe (Yd ehploynrsit tax liabllity gene€lly wlll bo $1,000 or l€ss lf you dp&t to pay $4,@0 or les in iolal wag€,) It you do not ctFk this bd, yd must file Fom 941 ld 0 0 t7 ls a withholdlng agsl, enter date in@m€ wlll frBl be paid to FtBt date wags or annuftte w4 paid (month, day, year). Not€i ll opdldt > DE*mbor 5 ry1 ye64 noFsldent all€n {mdsl, day, : ydr pindpat H€dfr ce & sodal Nistan€ of b!sin6& E whol€sal€-agsvbrokd actist E ch€ck dro box that bsr dewibs th6 seNi@ E F.iall ?€commodarion liood E wholeele other rtusMddaw6Ehous,ns E nstaareing B E cosrruaon E prcdud $lling digikl > Financ€ & insu€fto tr net estt6 E Indicaie orlnclpal llne of merchandl* eld, sp€iiic @rsttuction wolk done, prodocts produc€d, or wic€6 provn€d. 16 Has th€ applcarn €rnlty shown d t5 to ."rr'..ry oompbb rhlsscdM dlr ll n6 | evs aop ied 'd and @6Ned m EIN? 10tucdw lh€ wad lo .uthdi26thBnam6dndividual Ll Y.s El No eN 6ndahsd quGlios abql he D6rsn6 s rd.phda nunbor llidudD d@ cod€) Third Party Designs€ D€lsns |J|d'pd*lrBorpciury,Idro@trdItrasMmdlhisapplicatld,ddloIhob6lornvkio !dg6ddb.lid,ilclrucw.c1addpLt osr.r > Nad Yulandiani, s tax number(includeaE codo) Appl'crii'sld6Dhomnunbd lndudam code) 914-504-0682 Applicant'si8r numbd 0nclud€a@ @d€) 1-oLr 855330-1010 Act Notice se separab hslrlcrbns.