RESET
PRINT
Nebraska Limited Focus Examination Questionnaire
Please answer all applicable questions and return in the envelope provided.
BUSINESS IDENTIFICATION
Legal Name
Federal Identification Number or Social Security Number
Doing Business As
Nebraska Identification Number
BUSINESS LOCATION ADDRESS
ADDRESS WHERE THE EXAMINATION WILL BE CONDUCTED
Street Address
Street Address
City
State
Zip Code
City
State
Zip Code
Name of Person to Contact Concerning Examination or Power of Attorney
Title
Telephone Number
FAX Number
E-Mail Address
BUSINESS INFORMATION
1. Name of parent company, if appropriate:
2. List all related companies, or corporations that have at least 50 percent common ownership.
3. Type of ownership:
Sole Proprietorship
Partnership
S Corporation
C Corporation
LLC
LLP
Nonprofit Corp.
Owners/Officers and Titles
4. List all website addresses:
5. List all Nebraska locations:
6. Type of Business (check all that apply):
Retail
Wholesale
Manufacturing
Contractor
Rental
Utility
Hotel
Restaurant
Bar/Tavern
7. Describe your business activity. (Products and/or services sold):
8. Registered Contractor Option:
Option 1 — Buying inventory tax-free, and charging your customers sales tax on all materials.
Option 2 — Buying inventory tax-paid, and not charging customers sales tax on materials.
Option 3 — Buying inventory tax-free, paying use tax when the materials are withdrawn from inventory, and not charging
customers sales tax on materials.
SALES INFORMATION
9. Do you maintain a sales journal showing each sales invoice?
YES
NO
10. Does your sales journal show which sales have been taxed?
YES
NO
11. Are sales to out-of-state customers specifically identified in the sales journal?
YES
NO
12. What sales do you make that are not taxed?
13. Do you have Nebraska Resale or Exempt Sale Certificates, Forms 13, on file for
all nontaxed sales?
YES
NO
14. Do you donate or give away merchandise for promotional purposes, or do you
withdraw merchandise from inventory for personal or business use?
YES
NO
15. How are your sales invoices stored and filed?
7-286-2010