Nexus Questionaire Form - Division Of Taxation Nexus Audit Group - 2010
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STATE OF NEW JERSEY DEPARTMENT OF TREASURY
DIVISION OF TAXATION
NEXUS AUDIT GROUP
PO BOX 269, TRENTON NJ 08695-0269
NEXUS QUESTIONNAIRE
The purpose of this form is to determine the extent of your company’s business activity WITHIN the State of New Jersey.
Please answer all questions. You may attach additional riders if necessary.
A: GENERAL INFORMATION
1.
Identification
Legal Name
Business or Trade Name
Employer Federal ID Number (FEIN)
New Jersey State Corporation Number
Fiscal Year End
Headquarters/Main Office
Address
City, State & Zip
Web Address
Contact Person
Email Address
Telephone
FAX
2.
Type of Business Entity (check one)
Corporation:
State of Incorporation
Date of Incorporation
Partnership: List all Partners, FID or SSN#, and Addresses on a separate rider
Proprietorship: List Owner Name and Social Security Number
Owner Name
SSN#
Limited Liability: List type (e.g. LLC, LLP, Single Member)
a) Indicate which form you file with the IRS (e.g., 1120, 1065)
b) If you file form 1065, list all members with FID or SSN# and address on a rider.
c) If you are a Disregarded Entity, list the owner or owners with FID or SSN# and address on a rider.
Tax Exempt or Non-Profit: Please attach IRS Documentation
3.
List all certificates, registrations, licenses, and authorizations issued by any New Jersey State Agencies and
date issued. Complete even if certificates etc. have expired or been withdrawn. In such cases indicate ending
date. (If none, write none.)
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