Nexus Questionaire Form - Division Of Taxation Nexus Audit Group - 2010 Page 2
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44.
Did your organization, currently or at any time, have any agents, independent representatives,
subcontractors,third parties, etc. who worked on your behalf in New Jersey?
No
Yes. Please state the names and addresses of all agents, independent representatives, sub-contractors, third
parties, etc. who worked on your behalf in New Jersey, on a separate rider.
5.
Provide the address where the books and records are located.
Street
City, State & Zip
Contact Person and Phone Number
If the books and records are located in New Jersey, please provide the date that the location was established.
Provide the address where the actual seat of Management and Control is located.
6.
Street
City, State & Zip
Contact Person and Phone Number
If located in New Jersey, please provide the date that the location was established.
7.
Is this entity related to any others (parent, subsidiary, etc.) with business activities in New Jersey
No
Yes; please provide the complete name and address of each related company, the manner in which it is
related and the type of business conducted in the State of New Jersey. Also, if this entity has or had at any
time, any activity at any related company's New Jersey address, please describe, in detail, any inter-company
transactions. Please provide the aforementioned on a separate rider.
8.
Is this entity a partner in a partnership or LLC doing business in or deriving income from New Jersey?
No
Yes; please provide the name and address of each partnership or LLC and all partners on a separate rider.
Also indicate the date that this entity became a partner, and when the partnership or LLC commenced business
in or began deriving income from New Jersey.
9.
Status of Business
Active
Dormant, Inactive
Dissolved (Attach Certificate of Dissolution)
Non Survivor of Merger (Please provide the following information on a separate rider: date of merger,
name, address and Federal ID# of surviving entity.)
Other (Please provide details on a separate rider.)
10.
Total gross revenue for past 4 years as reported to IRS:
Gross
Gross
Tax
Revenue
Revenue
Tax Year
Year
Gross
Gross
Tax
Revenue
Revenue
Tax Year
Year
11.
Total gross income from New Jersey for past 4 years:
NJ
NJ
Tax
Revenue
Revenue
Tax Year
Year
NJ
NJ
Tax
Revenue
Revenue
Tax Year
Year
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