Form 4458 - Business Activity Questionnaire - 2016 Page 2
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5c) Nature of business activity: _____________________________________________________________________________________________
d) Telephone number listed in a directory or any toll free number for use by callers in Missouri: (__ __ __) __ __ __-__ __ __ __
e) Websites: __________________________________________________________________________________________________________
7.
Does your business or any affiliated entity currently use, maintain, lease, own, rent, or hold title to, or in the past,
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used, maintained, leased, owned, rented, or held title to, any tangible property located in Missouri? . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
If yes, briefly describe the property, and state the year(s) it was in Missouri: ________________________________________________________
____________________________________________________________________________________________________________________
Name the entity or entities which owned, leased, or otherwise utilized property in Missouri. ____________________________________________
____________________________________________________________________________________________________________________
8.
Value of real or tangible personal property held by the business or affiliated entity in Missouri for the last five years:
20__ __
20__ __
20__ __
20__ __
20__ __
$
$
$
$
$
Inventory
$
$
$
$
$
Other Property
$
$
$
$
$
Rental Property (annual)
$
$
$
$
$
Total
a) Address where inventory in Missouri is or was located: ______________________________________________________________________
b) Address and description of other property in Missouri: ______________________________________________________________________
c) Address and telephone number of all offices, displays, or sample rooms your business or any affiliated entity maintains or maintained in
Missouri: __________________________________________________________________________________________________________
9.
Has your business or affiliated entity licensed intangible property for use in Missouri?
Date
Location
Description
(MM/DD/YYYY)
10. Has your business conducted any type of research or testing in Missouri, either by your business or through an
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affiliated entity or representative? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
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11. Does your business or affiliated entity maintain a bank account in Missouri? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
12. Does your business or affiliated entity currently have or has it ever had a security interest in any real or personal
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property sold or located in Missouri? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
13. Has your business extended credit or financial services to any entity in Missouri? This includes issuing
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credit cards,debit cards, charge cards, making loans, and accepting mortgages to secure loans. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
14. Does your business or any affiliated entity currently own or has it ever owned advertising material directed to
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potential customers in Missouri? (If yes, attach a copy.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
15. Is your business or any affiliated entity listed in any telephone or building directory in Missouri?
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(If yes, attach a copy.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
16. Does your business or any affiliated entity currently engage or has it engaged in any advertising
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(cooperative or otherwise) directed to potential customers in Missouri? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
17. Has your business or any affiliated entity had representatives whom directly or indirectly referred potential customers
to your business for a commission or other consideration, whether by a link on an internet website, an in-person oral
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presentation, telemarketing, or otherwise? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
If yes, explain: ________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
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Parent category: Financial