Form Nexus - Nexus Questionnaire
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9MONTANA
NEXUS
Clear Form
Rev 05 14
Nexus Questionnaire
Part I. General Questions
1. Department of Revenue Representative ______________________________________________________________
2. Entity Information
Type of Business (please mark one box)
______________________
C Corp
S Corp
Partnership
Exempt from Tax
Other (Specify)
Legal Name of Business
Contact Person
d/b/a Name
Contact Phone
Street Address
Contact Email
City/State/Zip
Business Web Address
Federal Employer
Period End Date
-
M M / D D
Identification Number
(month and date only)
Montana Secretary of State
Date of
M M D D Y Y Y Y
ID Number
Formation
State or Country of Formation
Date Business Began Activity in Montana*
* If you have not yet begun to do business in Montana, please state so and answer the rest of the
questionnaire according to how the company plans to do business in Montana.
3. Explain the nature of your overall business and give a description of the property and/or services sold _____________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
4. Are you a sole proprietor, disregarded entity or a single member LLC? If yes, provide the owner’s
name and SSN or FEIN ............................................................................................................................
Yes
No
Name _______________________________________________________ SSN/FEIN _______________________
5. Status of Your Business (please mark one box)
Active
Dormant
Dissolved
Non Survivor of Merger
Other (Specify) ___________________________
6. Is this business the survivor of a merger with another business that was formerly a Montana
taxpayer? If yes, provide the name and FEIN of the surviving and non-surviving business and the
date of the merger. ....................................................................................................................................
Yes
No
Date _____________ Survivor’s Name __________________________________FEIN _______________________
Non-Surviving Business Name _________________________________________FEIN _______________________
Answer all the following questions as they relate to the business’ activities in Montana during the past ten years. Space is
provided on the last page of the questionnaire for detailed explanation of all “Yes” answers. Number your explanation to
agree with the part and number of the question answered.
7. Describe your principle business activity in Montana ____________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
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