Form 1353 - Michigan Department Of Treasury Nexus Questionnaire - 2009 Page 3

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1353, Page 3
Number of Days During
Last Four
Completed
the 12-Month Taxable Year
Activity Conducted in Michigan
Tax Year(s)
0
1
2 or more
(MM/DD/YY)
Yr1
Yr2
Conduct training for customers or potential customers.
Yr3
Yr4
Provide customers with any kind of technical assistance or
Yr1
service including, but not limited to, engineering assistance,
Yr2
design service, quality control, product inspections, or
Yr3
similar services, when one of the purposes is other than the
facilitation of the solicitation of orders.
Yr4
Yr1
Investigate, handle, or otherwise assist in resolving
Yr2
customer complaints, other than mediating direct customer
complaints when the sole purpose of such mediation is to
Yr3
ingratiate the sales personnel with the customer.
Yr4
Yr1
Yr2
Provide consulting services.
Yr3
Yr4
Yr1
Yr2
Solicit, negotiate, or enter into franchising, licensing or
similar agreements.
Yr3
Yr4
Michigan Business Tax
Beginning January 1, 2008:
8. Is your company a member of a Unitary Business Group (UBG)?
Yes, UBG FEIN (if known):__________________
No
9. Did your company or the UBG:
A. Actively solicit sales in Michigan? (see page 4 for definition of Actively solicits)
Yes, enter year(s)_______________________________________________________
No
How did your company or the UBG solicit sales in Michigan? Check all that apply.
The use of mail, telephone, and e-mail
Advertising, including print, radio, internet, television, and other media
Maintenance of an internet site over or through which sales transactions occur with persons within Michigan
Other (specify):_________________________________________________
B. Have gross receipts of $350,000 or more per year sourced to Michigan? (see page 4 for definition of Gross Receipts and
Sourced to Michigan)
Yes, enter year(s)____________________________________
No
I declare, under penalty of perjury, that the information provided in this questionnaire and any attachments is, to the best of my knowledge,
true, correct and complete. If prepared by a person other than an officer, partner or owner of the business, this declaration is based on all
information of which you have knowledge.
Signature of Officer, Partner or Owner
Date
Telephone Number
Print or Type Name and Title
Mailing Address if different than address on Page 1
Signature of Preparer
Date
Telephone Number
Print or Type Name and Title
Preparer's Mailing Address
For a more complete explanation of Michigan's Single Business Tax Nexus Standard, Use Tax Nexus Standard, Michigan Business
Tax - "Actively Solicits" and Michigan Business Tax Nexus Standard defined, call (800) 367-6263 and request Revenue Administrative
Bulletins (RABs) 1998-1, 1999-1, 2007-6 and 2008-4 or visit Treasury's Web site:
Continued on next page.

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