Form Cba-1 - Notice Of Business Activities Report By A Foreign Corporation Page 2

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FOR DIVISION USE ONLY

Corporate Name___________________________________________________________________

Federal ID # _________-_________-_________ / _________

F/Y/E _______/_______/_______

Rec’d ________/_______/________

Answer All Questions (See Instructions for Explanations):

DID THIS CORPORATION, now or ever, conduct any of the following activities in New Jersey:

YES

If “YES” insert first date (month and year) in yes box.

Month /Year

If “NO” insert “X” in no box.

1. Conduct any type of activity or engage in any interrelationships within New Jersey? . . . . . . . . . . . . . . . .

2. Derive Income from sources located in New Jersey? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If yes, specify: Type _________________________ Approximate amount $_______________________

3. Solicit sales in New Jersey? If yes, specify: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

¨ For product

¨ By In-State Reps, etc.

¨ For services

¨ By mail or phone only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4. If you have in-state solicitation of product is sales acceptance and/or approval:

¨ By salesman at New Jersey customer

¨ At corporate office located outside of New Jersey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5. If you have in-state salespeople with in-home offices in New Jersey, do you reimburse them for the

expense of maintaining such space in their home? If yes, submit copies of vouchers. . . . . . . . . . . . . . . .

6. Own, rent or lease any type of property located in New Jersey either for your own or other use? . . . . . . .

7. Do you license the use of intangible rights to clients located in New Jersey? . . . . . . . . . . . . . . . . . . . . . .

8. Provide any type of continuous maintenance program(s) which is/are preformed in New Jersey by this

entity or by any sub-contractor or independent contractor? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

¨ Your own trucks

¨ Common Carrier

9. Deliver goods to points in New Jersey?

If delivery in your own trucks, do you assist in set-up, installation or pick up of damages, returned or

replaced goods? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10. Perform any type of service in New Jersey, not related to solicitation of sales? . . . . . . . . . . . . . . . . . . . .

11. Do you own or lease any vehicles which are registered in New Jersey? If yes, are they assigned to:

¨ Salespeople only

¨ Salespeople and others

¨ Others

12. Is this corporation a partner in a partnership located or doing business in New Jersey? If yes:

¨ General Partner

¨ Limited partner with involvement

¨ Limited Partner with no involvement

In conclusion, is this corporation otherwise subject to tax under either the Corporation Business Tax Act

(N.J.S.A. 54:10A-1, et seq.) or the Corporation Income Tax Act (N.J.S.A. 54:10E-1, et seq.) . . . . . . . . . . . . . . . . . . . . . . . . . . ¨ YES

¨ NO

have any obligation to obtain a certificate of authority to do business in this State.

(as qualified and issued by the Secretary of State) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ¨ YES

¨ NO

SUBMIT COMPLETED FORM

CERTIFICATION OF AN AUTHORIZED OFFICER OF THE CORPORATION

TO:

NJ Division of Taxation

I hereby certify that this report, including any attachments, is to the best of my knowledge and belief, a true,

Audit Services Branch

correct and complete report.

50 Barrack Street

PO Box 269

___________________________________________________________________________________________

Trenton, NJ 08695-0269