Form R-4310 - Questionnaire To Assist In Determining Liability For Corporation Income Tax Or Corporation Franchise Tax

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R -4310 (7/07)
Questionnaire To Assist In
Determining Liability For
Corporation Income Tax Or
Corporation Franchise Tax
Company Name
La Account Number
FEIN
Address
City
State
ZIP
The following questions will assist us in determining whether your company is liable for Louisiana corporation income tax or
corporation franchise tax.
Please complete this questionnaire, attach any additional information you wish to include, and return to the Louisiana Department
of Revenue, Office Audit Division, Attn. ICFT Unit, PO Box 66362, Baton Rouge, Louisiana 70896-6362 or fax to (225) 219-2267.
A. Nexus Questionnaire
1.
Is this entity a corporation, a disregarded entity (such as a single-member LLC or QSSS), or a partnership,
❏ ❏ Yes ❏ ❏ No
LLC, or other entity that elects to file as a corporation for federal income tax purposes?
If yes, please explain .
❏ ❏ Yes ❏ ❏ No
2.
Does this company sell tangible personal property into Louisiana?
If yes, fully describe the sales process, including whether sales personnel, technical personnel or independ-
ent representatives come into Louisiana for any reason related to the sales. Also, complete Part B.
3.
Fully describe any types of services that are performed by this company in Louisiana or for or on behalf of an
entity in Louisiana including the frequency and duration of the performance of the services.
4.
Fully describe any other trade or business that is conducted in Louisiana or for or on behalf of an entity in
Louisiana including the frequency and duration of the conduct of the trade or business.
5.
Does this company license any type of intangible right to any entity that uses the right in Louisiana or that has
❏ ❏ Yes ❏ ❏ No
customers in Louisiana?
Please explain.
6.
What is the approximate number of Louisiana customers and the type or class of customers to whom
your products are sold, for whom your services are provided, or for whom your other type of trade or business
is conducted?
7.
Please describe any other connection this company has to Louisiana, including transporting or delivering
products or merchandise into or through the state or otherwise entering the state. Please include the
frequency and duration or other appropriate measurement of the extent of your connection to this state.

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