Fillable Form Ap-114 - Texas Nexus Questionnaire (Page 2 of 2) in pdf

Form AP-114 (Back)(Rev.5-12/16)

12.

Please check the items pertaining to this entity in Texas during the last seven years. (continued)

Start Date

month

day

year

Inventory

(including consigned goods)

Loan production activities

(solicit sales/loan contracts, gather data, make credit checks or other

financial activities in Texas with own employees, independent contractors or agents)

Solicitation

(promote sales/service using employees, independent contractors, agents or other representatives)

Employees/independent representatives

(including temporary employees, contractors, agents)

Sell and license software in Texas

Processing, manufacturing, storing goods

Processing and shipment

(send materials to Texas manufacturer, processor, repairer or printer to be

processed, stored in completed form, awaiting orders for shipment)

Advertising

(enter Texas to purchase, place or display advertising for the benefit of another)

Provide a service

(through employees, independent contractors, agents or other representatives)

Federal enclave

(doing business in Texas even if the area is leased, owned or controlled by the federal government)

Holding company

(maintain place of business, manage, direct and/or perform services for subsidiaries or related entities)

Transportation

(carry passengers or property where the pickup and delivery is in Texas; have Texas facilities, employees or

other representatives for storage, delivery, shipping of goods; servicing, maintaining, repairing vehicles or

other equipment; coordinating/directing the transportation of passengers or property)

Franchisors

(contracts where a franchisee is granted the right to engage in business under a marketing

plan/system substantially prescribed by the franchisor or if franchisee's business is substantially

associated with the franchisor's brand, service mark or other commercial symbol)

13.

Please provide a full description of the entity's activities in Texas. If the entity no longer has nexus in Texas, enter the

end date of the entity's activities in Texas and provide the reason why this entity does not have Texas franchise tax

Nexus end date

responsibility.

_________________________________________________________________________________

month

day

year

________________________________________________________________________________________________

14. Please complete this information for all members, all general partners and each limited partner with a 10% or more

interest in the partnership. (For limited partnerships, general partnerships, joint ventures and joint stock companies.)

(Attach additional sheets if necessary.)

Name

Type of owner

FEIN

Percentage of ownership

General

Limited

Member

Partner

Mailing address

City

State

ZIP code

Begin date in Partnership

Printed name

Title

Name

Type of owner

FEIN

Percentage of ownership

General

Limited

Member

Partner

Mailing address

City

State

ZIP code

Begin date in Partnership

Printed name

Title

Name

Type of owner

FEIN

Percentage of ownership

General

Limited

Member

Partner

Mailing address

City

State

ZIP code

Begin date in Partnership

Printed name

Title

I declare that the information in this document and any attachment is true and correct to the best of my knowledge and belief.

Print preparer's name

Title

Phone (Area code and number)

Date

Please return this completed questionnaire to:

Information about franchise tax is available online at

Texas Comptroller of Public Accounts

For taxpayer assistance, call 1-800-252-1381 or 512-463-4600.

P.O. Box 149348

Austin, TX 78714-9348

Form Ap-114 - Texas Nexus Questionnaire Page 2

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