Schedule N - Nexus-Immune Activity Declaration
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1SCHEDULE N
NEXUS-IMMUNE ACTIVITY DECLARATION
(12-02)
For Periods Beginning Before January 1, 2002
For taxable year beginning _____________________, ________ and ending _____________________, ________
CORPORATION NAME
FEDERAL ID NUMBER
Read the instructions on the reverse side before completing this schedule.
Did this corporation, during the period covered by this return, perform any of the following activities in New Jersey:
Yes
No
(1) Own, lease or rent any real property in New Jersey?
Yes
No
(2) Lease tangible property to others for use in New Jersey?
Yes
No
(3) Own or lease vehicles registered in New Jersey which are provided to people who are not sales people?
Yes
No
(4) Own, lease or rent any type of property located in New Jersey (consignments, inventory, drop shipments, or like
transactions)?
Yes
No
(5) License the use of any intangible rights from which royalties, licensing fees, etc., are derived for the use of these
rights in New Jersey (for example without limitations, software licenses, trademarks)?
Yes
No
(6) Solicit sales in New Jersey for services through the use of employees, officers, agents and/or independent
contractors or representatives?
Yes
No
(7) Perform any type of service in New Jersey (other than solicitation) such as constructing, erecting, installing,
repairing, consulting, training, conducting seminars or meetings or administering credit investigations through
the use of employees, agents, sub-contractors and/or independent contractors or representatives?
Yes
No
(8) Provide any technical assistance or expertise which is performed in New Jersey through the use of employees,
agents, sub-contractors and/or independent contractors or representatives?
Yes
No
(9) Perform any detail work in New Jersey without limitations such as taking inventory, stocking shelves,
maintaining displays, arranging delivery through the use of employees, agents, sub-contractors and/or
independent contractors or representatives?
Yes
No (10) Carry goods, merchandise, inventory, or other property into New Jersey for direct sale to customers in New
Jersey?
Yes
No (11) Pick-up and/or replace damaged, returned or repossessed goods from New Jersey customers with company
owned vehicles or through contract carriers?
Yes
No (12) Make pick-ups or deliveries to points in New Jersey with company owned vehicles or through contract carriers?
Transportation Companies Only.
Yes
No (13) Provide any type of maintenance program which is performed in New Jersey by either this entity or an
independent contractor?
Yes
No (14) Have sales representatives who have the authority to accept or approve sales orders from customers located in
New Jersey in which acceptance/approval takes place in New Jersey and not from an out-of-state location?
Yes
No (15) Have employees, independent contractors or representatives with in-home offices in New Jersey for which they
are reimbursed for expenses other than telephone or travel?
Yes
No (16) Serve as a general partner in a partnership doing business in New Jersey?
Yes
No (17) Secure deposits for sales or payment for sales and /or deliveries?
Yes
No (18) Allow catalog or on-line sales to be returned or picked up at an in-store location of a related or affiliated
company?
Yes
No (19) Collect delinquent accounts directly or indirectly or repossess property?
AFFIRMATION OF INFORMATION BY AN OFFICER / RESPONSIBLE INDIVIDUAL
I hereby certify that this schedule, including any accompanying riders, is to the best of my knowledge a true, correct and complete report.
Name: ____________________________________________
Title: ____________________________________
Signature:__________________________________________
Date: _____________________________________
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