Form Ftb 4684a - Demand For Tax Return - Questionnaire

Reply to FTB

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Entity ID Number:

YES

9. Did your entity have consigned merchandise in California?.........................................................

If yes, provide the nature and cost of the consigned merchandise:

10. Did your entity maintain merchandise or inventory in California (e.g., in a distribution

YES

warehouse/public warehouse)?..................................................................................................

YES

11. Did your entity execute contracts or similar agreements in California?......................................

YES

12. Did your entity participate in a trade show in California?............................................................

If yes, provide the location, number of days, and total amount of gross sales from the

California locations:

13. Did your entity maintain a bank account or other investment account with a California bank,

YES

financial institution, or investment company?.............................................................................

If yes, provide the name and address of the bank and include a copy of your federal Form

1099 INT or 1099 DIV:

YES

14. Did a California member, shareholder, officer, or representative sign checks for your entity?...

15. Did your entity forbid (by contractual agreement or otherwise) commissioned agents or

YES

independent contractors from selling or promoting other manufacturer's products?..................

16. Did your entity have members/officers, employees, commissioned agents, or independent

contractors residing, selling, soliciting, providing services, or promoting missionary activities

YES

in California?...............................................................................................................................

If yes, describe the activities or services performed in California.

YES

17. Did your entity offer warranties?.................................................................................................

If yes, where was the warranty work performed?

18. Who provided your entity's warranty work within California?

Answer questions 19-30 to help us clarify the type of activities performed within California by your

entity, members/officers, employees, or independent agents for the year specified on this notice.

Indicate if any of the following activities were performed:

YES

19. Engaged in inspection services, maintenance, or repair work in California................................

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FTB 4684A (REV 07-2013) C3 PAGE 5

Form Ftb 4684a - Demand For Tax Return - Questionnaire - 2013 Page 3