Questionnaire Regarding Activities In Arizona Form - Arizona Department Of Revenue

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Arizona Department of Revenue
Nexus Unit
1600 W Monroe, Phoenix AZ 85007
Questionnaire Regarding Activities in Arizona
Questionnaire Regarding Activities in Arizona
Complete the Information Requested Below and Mail this Questionnaire to the above Address
We are conducting a survey to determine the extent of your company’s business activity within the State of Arizona.
Please check and fi ll in your responses as indicated. Use additional pages if necessary.
For the purpose of this questionnaire, “Company” refers to the business entity receiving this form.
A. Company Identifi cation
A. Company Identifi cation
1. Legal business name:
Common name (dba):
2. Headquarter offi ce address (number and street):
City, town or post offi ce
State
ZIP code
(
)
Telephone number:
Website:
Contact person:
Corporate offi cer:
Yes
No
(
)
(
)
Telephone number:
Ext.:
Fax number:
3. What type of entity is the Company (e.g. sole proprietorship, partnership, LLC, corporation):
4. Is the Company registered as a corporation with the Arizona Corporation Commission?
Yes
No
5. State of incorporation:
Date of incorporation:
6. Month and year Company began initial activity in Arizona:
/
.
B. Company Filing Status
B. Company Filing Status
1. Federal Employer Identifi cation Number:
2. What is Company’s fi scal year end?
3. Has Company elected to be taxed as an S corp?
Yes
No
4. Indicate the tax returns the Company has fi led with the State of Arizona:
Tax Return Type
Year Filed
Company Name
License / Tax Number
Corporate
Transaction Privilege
Withholding
Partnership/Sole Proprietorship
If you currently fi ling BOTH Corporate Income Tax Returns AND Transaction Privilege/Use Tax Returns to the State of Arizona, you may STOP HERE.
I declare that the information furnished in this questionnaire is true, correct and complete.
Signature of Corporate Offi cer, Partner or Owner
Date
Please Print Name and Title
ADOR 10894 (7/10)
Previous ADOR 20-1068

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