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is true, correct, and complete. Signature of income beneficiary Cr signature and title of legal representative or other qualified person making the Schen Date *Use Part III to make the OSST election only if stock of the corporation has been transferred to the trust on or before the date on which the
ormation Name (see instructions) Nautilus, Inc. Type or Print *nstructions.) A Employer Identification number B Date incorporated 11/22/2011 C State of incorporation St. Thomas, VI 00802 VI D Check he applicable box(es) if the corporation. after applying for the EIN shown in A above, changed it
is true, correct, and complete. Signature of income beneficiary Cr signature and title of legal representative or other qualified person making the Schen Date *Use Part III to make the OSST election only if stock of the corporation has been transferred to the trust on or before the date on which the
Name (see instructions) Maple, Inc. A Employer Identification number Type ns.t B oat or Print 11/22/2011 City or town. state. and ZIP code C State of incorporation St. Thomas, VI 00802 VI D Check the applicable box(es) if the corporation. after applying for the EIN shown in A above, changed i
is true, correct, and complete. Signature of income beneficiary Cr signature and title of legal representative or other qualified person making the Schen Date *Use Part III to make the OSST election only if stock of the corporation has been transferred to the trust on or before the date on which the
g with reference to the month of ► If box (2) or (4) is checked, complete Part II A Em to r Identification number B Date incorporated 11/22/2011 C State of incorporation VI changed its K name or K address ► 11 / 22 / 2011 usually enter the 0 If more than 100 shareholders are listed for item J
is true, correct, and complete. Signature of income beneficiary Cr signature and title of legal representative or other qualified person making the Schen Date *Use Part III to make the OSST election only if stock of the corporation has been transferred to the trust on or before the date on which the
Type I Number street, and room or stile no or Print box see instructions.) A B Date incorporated 11/22/2011 City or town. state. and ZIP code C State of incorporation St. Thomas, VI 00802 VI D Check he applicable box(es) if the corporation. after applying for the EIN shown in A above, changed it
Entities connected to both Schen and C State