Form Nexus - Nexus Questionnaire Page 3
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9Part I. General Questions - Continued
16. Have you received a letter from the Department of Revenue? If yes, provide the date and Letter ID. .....
Yes
No
Date _________________________
Letter ID _____________________________________
17. List names and addresses of your three largest customers in Montana
a)
__________________________________________________________________________________________
b)
__________________________________________________________________________________________
c)
__________________________________________________________________________________________
18. In the past ten years, did the business have any unrelated business income reportable on Federal
Form 990-T? .............................................................................................................................................
Yes
No
19. Enter net income (before net operating loss and special deductions, i.e. Line 28) on federal tax return
for last five years
a) 20 ______$ _______________
b) 20 ______$ _______________
c) 20 ______$ _______________
d) 20 ______$ _______________
e) 20 ______$ _______________
20. Enter amount of sales for the last five years
Tax Year Ended
Total Everywhere Sales
Total Montana Sales
a) _____/_____/______
$ ______________________________
$ ______________________________
b) _____/_____/______
$ ______________________________
$ ______________________________
c) _____/_____/______
$ ______________________________
$ ______________________________
d) _____/_____/______
$ ______________________________
$ ______________________________
e) _____/_____/______
$ ______________________________
$ ______________________________
Part II. Sales
1. Did you derive any type of income from sources located in Montana (sales receipts, fees for services,
franchise fees, royalties, licensing fees, rents, etc.)? If yes, please specify. ............................................
Yes
No
2. Do you solicit the sales of tangible personal or real property in Montana? ...............................................
Yes
No
3. Do you solicit the sales of services or intangible property in Montana? ...................................................
Yes
No
4. Do you provide services in Montana? .......................................................................................................
Yes
No
5. Please provide an explanation of how sales are made in Montana in the space provided on the last page.
6. Have sales to Montana customers been included in the another state’s sales factor? ............................
Yes
No
If yes, list the state(s) _______________________________________________________________
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