Questionnaire 21-004: Activities Within Iowa For A Corporation, Partnership Or Llc Page 5

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Page 5
19. Does the company have any franchises or licensing agreements or receive payments for the use of
trademarks or trade names in Iowa?
Yes _____
No _____
If yes, please provide a copy of the agreements or receipt of payments.
IOWA ACTIVITIES OF EMPLOYEES
IMPORTANT NOTICE: The remaining questions relate to employee activities in Iowa for the periods
on page 1. “Employees” means all people entering Iowa on company business regardless of domicile or
office location. If no employees travel in Iowa, go to question 30.
Select Yes or No, where applicable.
20. For all present and former employees who have entered Iowa, please complete the following (include
copies of the employees’ job descriptions and that of his/her immediate supervisor):
Name, Title & Mail Address
Date Hired Date Ended
________________________________________________________________
_______
_______
Division or Subsidiary_____________________________
Home Phone _______________________
Name, Title & Mail Address
Date Hired Date Ended
________________________________________________________________
_______
_______
Division or Subsidiary_____________________________
Home Phone _______________________
Name, Title & Mail Address
Date Hired Date Ended
________________________________________________________________
_______
_______
Division or Subsidiary_____________________________
Home Phone _______________________
Name, Title & Mail Address
Date Hired Date Ended
________________________________________________________________
_______
_______
Division or Subsidiary_____________________________
Home Phone _______________________
Name, Title & Mail Address
Date Hired Date Ended
________________________________________________________________
_______
_______
Division or Subsidiary_____________________________
Home Phone _______________________
21-004e (04/04/11)

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