Form Rev-203 Cm - Business Activities Questionnaire - 1999
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1
2REV-203 CM (6-99) (I)
BUSINESS ACTIVITIES
QUESTIONNAIRE
PA DEPARTMENT OF REVENUE
Please Print or Type
A. GENERAL INFORMATION
Federal EIN
Legal Name
Doing Business As (Fictitious Name)
1a
1b
2
Address
City
State
Zip Code
3
Type of Business entity. (Check one)
4
Corporation
Partnership
Individual
Non-profit Corporation
(Complete No. 5 Below)
(Attach list of partners &
(Proprietorship)
Subchapter “S” Corporation
Federal ID Nos.)
Limited Liability Corp.
Answer the following questions if the business entity is a corporation.
5
A.
The Corporation was incorporated on ____________________ under the laws of
B.
Has the corporation ever filed a Pennsylvania Corporate Tax Report? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
If yes, indicate the Pennsylvania Corporation Tax File (Box) Number.
C.
Has the corporation ever obtained a Certificate of Authority from the
Pennsylvania Department of State to do business in Pennsylvania? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
If yes, indicate date the Certificate was granted _____________________________________
D.
Corporation files Federal Corporation Income Tax Return on a tax year ending ______________________ basis.
(month)
E.
Attach a list of corporations related by ownership along with their Federal Identification Numbers and address. Include parent, subsidiary and affiliate corporations.
Was the business entity ever registered for Pennsylvania Sales and Use Tax purposes? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
6
If yes, indicate the Pennsylvania Sales and Use Tax License Number.
Was the business entity registered for Pennsylvania Unemployment Compensation purposes? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
7
If yes, indicate the Unemployment Compensation “Account Number”.
Also describe the activities in Pennsylvania of the employees for whom the business made UC contributions.
Has the business entity remitted Pennsylvania taxes for any other purpose? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
8
If yes, indicate the specific tax(es) and provide the tax identification number(s).
(a) Tax
Number
(b) Tax
Number
What are the principal business activities of the entity in Pennsylvania? Indicate the periods during which the entity conducted such activities in Pennsylvania.
9
What are the principal business activities of the entity elsewhere?.
10
B. PENNSYLVANIA BUSINESS ACTIVITIES
Answer the following questions based on the entity’s activities in Pennsylvania. If the business is a corporation, responses also should reflect the activities of a part-
nership or similar association in which the corporation has an interest. SPECIFY THE DATES THESE ACTIVITIES WERE PERFORMED INITIALLY IN PENNSYLVANIA.
CUSTOMER SERVICE AND DELIVERY
1
Check the different ways in which the entity’s personal property is delivered in Pennsylvania:
(a) ________ by common or contract carrier
(c) _______ by your agent
(e) _______ not applicable
(b) ________ by United States mail
(d) _______ by your own vehicles
2
Check the different advertising media you use to reach Pennsylvania customers:
(a) ________ local/regional newspapers
(e) _______ trade fairs or shows
(i) _______ radio
(b) ________ national newspapers/magazines
(f) _______ yellow pages
(j) _______ other/describe
(c) ________ direct mail advertising
(g) _______ local television
(k) _______ Internet
(d) ________ catalogs placed in outlets
(h) _______ national television
________________________________________
3
Check each of the following activities performed by any of your employees and indicate the dates the activities were performed in Pennsylvania.
STARTING DATE
ENDING DATE
(a) ________ Occasional or regular visits to Pennsylvania to create a demand for your
personal property or service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(a)
/
/
/
/
(b) ________ Solicitation of orders within PA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(b)
/
/
/
/
(c) ________ Approval of orders within PA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(c)
/
/
/
/
(d) ________ Repair or servicing of personal or real property within PA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(d)
/
/
/
/
(e) ________ Installation or assembly of products within PA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(e)
/
/
/
/
(f) ________ Collections activity or credit investigations within PA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(f)
/
/
/
/
(g) ________ Construction related activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(g)
/
/
/
/
(h) ________ Training personnel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(h)
/
/
/
/
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