Questionnaire Regarding Activities Form - Office Of State Tax Commissioner

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S
N
D
TATE OF
ORTH
AKOTA
O
S
T
C
FFICE OF
TATE
AX
OMMISSIONER
Cory Fong, Commissioner
Questionnaire Regarding Activities in North Dakota
During The Past Ten Years
Complete the information requested below and mail to:
North Dakota State Tax Commissioner
Corporate Income Tax Section
600 E. Boulevard Ave., Dept. 127
Bismarck, North Dakota 58505-0599
1.
Exact Corporation name and d/b/a name:
Phone:
Street address of Corporation
City
State
Zip Code
2.
Federal Employer Identifi cation No.:
3. State of Incorporation:
4. Date of Incorporation:
5.
Type of Corporation (C Corporation, S Corporation, LLC):
6.
Nature of business and description of property and/or services sold:
7.
Principal business activity in North Dakota:
8.
Date qualifi ed to do business in North Dakota, if registered:
9. Date North Dakota activity began:
10. Have you ever fi led returns with North Dakota? If yes, enter date of last return and exact name under which return was fi led:
Yes
No
Date
Name
Corporate Tax
Sales Tax
Workman’s Compensation
11. List names and addresses of your three largest customers in North Dakota:
(a)
(b)
(c)
12. Amount of sales for last three years:
Tax Year Ended
Total Everywhere
Total North Dakota
____/____/____
$ ____________________________
$ _____________________________________
____/____/____
$ ____________________________
$ _____________________________________
____/____/____
$ ____________________________
$ _____________________________________
13. Net income (before net operating loss deduction) on federal tax return for last three years:
20 ________ $ ____________________
20 ________
$ ____________________
20 ________ $ ____________________
14. List all states your corporation conducts business activities in:
___________________________________________________________________________________
15. List all subsidiaries, divisions, or parent corporations operating within North Dakota:
Name
Relationship
Address
(a) __________________________________
_____________________________
_______________________________________________
(b) __________________________________
_____________________________
_______________________________________________
(c) __________________________________
_____________________________
_______________________________________________
28819
600 E. B
A
., D
. 127, B
, N
D
58505-0599
OULEVARD
VE
EPT
ISMARCK
ORTH
AKOTA
701.328.2770 F
: 701.328.3700 H
/S
I
: 800.366.6888
.
.
/
@
.
.
AX
EARING
PEECH
MPAIRED
WWW
ND
GOV
TAX
TAXINFO
STATE
ND
US

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