SS4 - Application for LLC's EIN

12 Closing month of accounting year: December

13 Highest number of employees expected in the next 12 months (enter -0- if none)

If no employees expected, skip line 14.

Agricultural	Household	Other
0	0	0

15 First date wages or annuities were paid (month, day, year nonresident alien (month, day, year): N/A
16 Check one box that best describes the principal activity of your business

Other (Investing)
17 Indicate principal line of merchandise sold, specific construction work done, products produced, or services provided.

Other (Investing)
18 Has the applicant entity shown on line 1 ever applied for and received an EIN?

No
Complete this section only if you want to authorize the named individual to receive the entity’s EIN and answer questions about the completion of this form.
Third Party Designee

Designee’s name:
Daniel Gleich, Broad Financial LLC

Address and ZIP code:
One Paragon Drive, Suite 270, Montvale, NJ 07645

Telephone number (include area code):	Fax number (include area code):
(845) 352-3000	(845) 352-7575

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Applicant’s telephone number (include area code)
Applicant’s fax number (include area code)
Name and title
Signature*

Clear
MonthDayYear
Date
Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, it is true, correct, and complete.
I previewed this form by clicking "Preview PDF" below and confirm that all information on this Form SS-4 is accurate
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Form SS-4