Minnesota Business Activity Questionnaire Form
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5MINNESOTA Department of Revenue
600 N Robert Street, St. Paul, MN 55146
Phone: 1-800-657-3777
Minnesota Business Activity Questionnaire
Legal name of business:_______________________________________________________________________________________
Home office mailing address:___________________________________________________________________________________
Phone number: ( ______ ) _________________________________Fax number: ( ______ ) _________________________________
Federal employer identification number: ______________________________________ Date income year ends: _____/______/_____
Web address: _______________________________________
Email address: __________________________________________
Type of business:
Corporation
S-corporation
Partnership
Other:____________________________________
State and year of incorporation or organization: _____________________________________________________________________
Year of Sub-chapter S election: ________________________________________________________________________________
If S-corporation or Partnership, a) total number of shareholders or partners:_______________________________________________
b) percentage (%) ownership of the partner/shareholder owning the largest share: _______________%
Prior business name(s) and dates of incorporation or organization (if any):________________________________________________
___________________________________________________________________________________________________________
Principal product or service:____________________________________________________________________________________
Brand names of products or services:_____________________________________________________________________________
List the states or countries from where products/services are marketed or shipped: _________________________________________
__________________________________________________________________________________________________________
Section A
All yes answers must be explained in detail. Also, provide a copy of your most recent annual report.
1. Is your business qualified to do business in Minnesota with the Secretary of State? If yes, on what date?
Yes
No
2. Has your business ever filed with Minnesota: If yes, show year(s) at right.
year to year
Yes
No
Corporation Income Tax
______ ______
Yes
No
S-corp Income Tax
______ ______
Yes
No
Partnership Income Tax
______ ______
Yes
No
Sales/Use Tax
______ ______
Yes
No
Withholding Tax/Unemployment Tax
______ ______
Yes
No
Alcohol/Tobacco Taxes
______ ______
For those checked yes, show Federal Identification number if different than listed above.
MBAQ WEB-PAGE 1
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Parent category: Financial