Form M-4r - Minnesota Business Activity Report - 1998
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1MINNESOTA Department of Revenue
Minnesota Business Activity Report
M-4R
Read the instructions on the back before completing this form.
For calendar year __________________, or fiscal year __________________ to __________________.
Name of corporation
Minnesota ID number
FEIN
–
Street address
Are you a member of a
Do you make retail
sales in Minnesota?
unitary group?
City or town
State
Zip code
Yes
No
Yes
No
Principal office in Minnesota
Principal type of business
Street address
Principal product or service
City or town
State
Zip code
Amount of Minnesota sales (wholesale or retail) or receipts
$
Offices and other places of business in Minnesota. (Attach a list if you need more room.)
Location
Nature of activity
Officers, employees, agents and representatives with activity in Minnesota. (Attach a brief job description for each officer
and class of employee.)
Title
Number of persons
Read the instructions before completing this section. On a separate sheet, explain all “yes” answers in detail.
During the period covered by this report, did the corporation:
Yes
No
1 Own or lease tangible or intangible personal property or real property in Minnesota? . . . . . . . . . . . . 1
2 Employ or own any other assets in Minnesota? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Own or consign any merchandise located in Minnesota? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Own assets located in Minnesota that are leased to others? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Perform any training, installation or repair work in Minnesota? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
6 Derive income from services performed for persons or businesses located in Minnesota? . . . . . . . . . . 6
7 Derive income from any source within Minnesota, including income from activities
conducted by subsidiaries or affiliated entities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
I hereby certify that this report, including any accompanying material, is true, correct and complete to
the best of my knowledge and belief.
Authorized signature
Title
Date
Daytime phone
(
)
Mail to: MN Dept. of Revenue, Mail Station 5130, St. Paul, MN 55146-5130
Stock No. 4000030
Printed on recycled paper with 10% post-consumer waste using soy-based ink.
(Rev. 10/98)
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Parent category: Financial