Form Ap-114 -Texas Nexus Questionnaire
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2AP-114
(Rev.8-05/14)
TEXAS NEXUS QUESTIONNAIRE
Under Ch. 559, Government Code, you are entitled to review, request, and correct information we have on file about you, with limited exceptions in
accordance with Ch. 552, Government Code. To request information for review or to request error correction, contact us at the address or toll-free number
listed on this form.
1. Entity legal name and mailing address
INTERNAL USE ONLY
MISCAPP
00991
Job type:
T code:
Taxpayer number:
1324
Tax type and reason code:
Reference number:
File number:
2A. If the information printed above is incorrect, enter the correct information.
Entity legal name
Business phone (Area code & number)
Street Address or P.O. Box
City
State
ZIP Code
County Code
2B. Business name ("Doing Business As" or "DBA")
3A. Federal E.I. Number
3B. Does the entity have any Texas tax permit number(s) issued by the Texas Comptroller of Public Accounts - (Sales, Use, Fuels, etc.)?
(If yes, please list.)
4. Type of business (If "D" is checked, attach a list of general partners, names, FEIN, and addresses.)
E. Other
A. Corporation
B. Limited Liability Company
C. Sole Proprietorship
D. Partnership
5A. State of formation
5B. Date of formation
5C. Has the entity been involved in a merger within the last seven years? 5D. Accounting year end
(Attach a detailed explanation.)
YES
NO
6. Do you have a Certificate of Authority to do business in Texas issued by the Texas Secretary of State (SOS)?
YES
NO
(If "YES," please provide the SOS file number and the date issued.)
SOS file number
Date issued
7. Briefly describe the entity's
business activities in Texas.
SIC code
8. Contact person and mailing address
9. Daytime phone (Area code and number)
10. E-mail address
11. Web site address
12. Check the items you have located in Texas.
A. MANUFACTURING PLANT
E. REAL PROPERTY
I. SPACE IN DEPT. OR CHAIN STORE
B. OFFICE
F. PERSONAL PROPERTY
J. TERMINAL FACILITY
C. WAREHOUSE
G. STOCK OF GOODS, INVENTORY
K. EMPLOYEES
(owned or leased)
D. RETAIL OUTLET
H. LEASED PROPERTY
L. INDEPENDENT REPRESENTATIVES
ANSWER THE QUESTIONS BELOW AS THEY PERTAIN TO THE LAST 7 YEARS.
YES
NO
Date
13. Does the entity do any of the following in Texas
(If "YES," indicate beginning date.)
A. solicitation: have employees, independent contractors, agents, or other representatives in Texas to
promote or induce sales of the entity's goods or services;
B. services:
1. provide any service in Texas (regardless of whether the employees, independent contractors,
agents, or other representatives performing the services reside, have a home office or have a
place of business in Texas);
2. install, erect, modify, maintain, or repair real or personal property in Texas; or
3. do warranty work in Texas, regardless of whether such warranty work is done by a third party.
C. place of business: maintain a place of business in Texas;
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