Form Ftb 1063a - Questionnaire Regarding Activities In California - State Of California Franchise Tax Board Page 2

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18. Please indicate the type of activities performed by employees or independent contractor agent(s) in California.
Yes
No
(a) Are California employees authorized to approve sales? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(b) Are deliveries made from a point in California? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(c)
Is there a permanent sample or display room in California? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(d) Are sales solicited to be delivered from California inventory? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(e) Is there a repair shop located in California? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(f)
Is there a liaison office located in California? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(g) Is installation performed in California for products sold? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(h) Is there a parts department in California? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(i)
Is repair or alteration work performed in California? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(j)
Is warranty work performed in California? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(k)
Is there a regular practice of sale or delivery of sample stock in California? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(l)
Are training courses or lectures conducted in California? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(m) Are credit investigations handled in California? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(n) Are complaints handled in California? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(o) Are past due accounts collected in California? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(p) Is damaged or returned merchandise picked up in California? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(q) Are employees or independent contractor agent(s) activities limited to soliciting sales? . . . . . . . . . . . . . . . . . . . . . . . . . . .
(r)
Is the corporation a member of a California partnership doing business in California? . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If yes, provide the exact name and address of the partnership and its California identification number_________________________________
_________________________________________________________________________________________________________________
(s)
Are there other types of activities in California? Please explain:_______________________________________________________________
_________________________________________________________________________________________________________________
(t)
If answer to (n), (o) or (p) is yes, please explain extent and frequency:__________________________________________________________
_________________________________________________________________________________________________________________
(u) If any of the above activities are performed by independent contract agent(s) only, please describe the activities by the appropriate
alphabetical reference(s) and provide name and address of the agent(s).
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Yes
No
Do any of the agents in California represent this corporation only? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Under penalty of perjury, I declare that the information furnished in this questionnaire is, to the best of my knowledge
and belief, true, correct and complete. If prepared by a person other than an officer of this corporation, this declaration
is based on all information of which he or she has knowledge.
DATE
SIGNATURE OF OFFICER
PHONE
TITLE
PLEASE RETURN WITH A COPY OF
OUR LETTER TO INSURE PROPER
IDENTIFICATION
FTB 1063A (REV 7-94) PAGE 2

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