Minnesota Business Activity Questionnaire Form (Page 5 of 5) in pdf

Section E

Affiliated Companies

1. Does your business own more than 50% of another business?

Yes

2. Does another corporation own more than a 50% interest in your business?

Yes

If yes to either of the above questions, please provide a schedule listing their names, addresses, and federal identification numbers.

3. Do any affiliated companies: (Check all that apply)

File income tax in Minnesota?

File sales tax in Minnesota?

File withholding (payroll) tax in Minnesota?

Make any mail order sales to Minnesota customers?

Have destination sales in, or receipts from, Minnesota?

Solicit, distribute or service products in Minnesota of other members of affiliated group?

Perform any services or provide facilities for affiliated companies in Minnesota?

For those checked above, list business, Minnesota ID number, activity, dates, and location.

_______________________________________________________________________________________________________

Did you include:

Detailed answers to all questions answered yes?

Product brochure?

Job descriptions?

A copy of the most recent annual report?

Independent contractor agreements?

Affiliation schedule?

Please provide any additional information which may be useful in determining whether your business has a filing requirement for any tax

in Minnesota.

MINNESOTA Department of Revenue

600 N Robert Street, St. Paul, MN 55146

Phone: 1-800-657-3777

I declare that the information furnished in this report, including accompanying statements, contracts, andschedules, is to the best of my

knowledge and belief, true, correct and complete.

Signature

Date

Name of person(s) who prepared questionnaire

Title

Daytime phone

(

)

Office Use Only

Mail Station:___________ Date Sent:___________________ Project: _________________

RTS:__________________ Activity:_____________________ Referral: _________________

Control Number:____________________________________

1/99

MBAQ WEB-PAGE 5

Minnesota Business Activity Questionnaire Form Page 5