Form Cba-1 - Notice Of Business Activities Report By A Foreign Corporation Page 2

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Corporate Name _________________________________________________________________________
Federal ID#
________________________________________________
F/Y/E __________ / __________ / __________
Answer All Questions (See Instructions for Explanations):
DID THIS CORPORATION, now or ever, conduct any of the following activities in New Jersey:
If "YES" insert first date (month and year) in yes box.
YES
NO
If "NO" insert "X" in no box
Month/Year
X
Conduct any type of activity or engage in any interrelationships within New Jersey? ............................
1.
Derive Income from sources located in New Jersey?
2.
If yes, specify: Type ____________________ Approximate amount $_________________ ………..
Solicit sales in New Jersey? If yes, specify:
3.
For product
By In-State Reps., etc.
Internet or Electronic Means
For services
By mail or phone only .. …………………………....…………
If you have in-state solicitation of product is sales acceptance and/or approval:
4.
By salesman at New Jersey customer
At corporate office located outside of New Jersey …………………………………….………
If you have in-state salespeople with in-home offices in New Jersey, do you reimburse them for the
5.
expense of maintaining such space in their home? If yes, submit copies of vouchers .........……….….
Own, rent or lease any type of property located in New Jersey either for your own or other use? ..……
6.
Do you license the use of intangible rights to clients located in New Jersey? ………………………….
7.
Provide any type of continuous maintenance program(s) which is/are performed in New Jersey by this
8.
entity or by any sub-contractor or independent contractor? .………………………………….………..
9. Deliver goods to points in New Jersey?
Your own trucks
Common Carrier
If delivered in your own truck, do you assist in set-up, installation or pick up of damages, returned or
replaced goods? ………………………………………………………………………………………….
10. Perform any type of service in New Jersey, not related to solicitation of sales? ......................................
11. Do you own or lease any vehicles which are registered in New Jersey? If yes, are they assigned to:
Salespeople only
Salespeople and others
Others ……………….
12. Is this corporation deriving income as a partner/member of any Partnership or LLC located or doing
business in New Jersey? If yes, describe this corporation's involvement:
___________________________________________________________________________________
In conclusion, is this corporation otherwise subject to tax under either the Corporation Business Tax Act
(N.J.S.A. 54:10A-1, et seq.) ……………………………………………………………………………………
YES
NO
or
have any obligation to obtain a certificate of authority to do business in this State. (as qualified and issued by
the Division of Revenue, Commercial Recording Bureau …………………………………………………………
YES
NO
CERTIFICATION OF AN AUTHORIZED OFFICER OF THE CORPORATION
SUBMIT
COMPLETED
FORM 
 
 
I hereby certify that this report, including any attachments, is to the best of my knowledge and belief, a true,
TO: 
NJ
D
T
 
 
IVISION OF 
AXATION
correct and complete report.
O
A
B
 
FFICE 
UDIT 
RANCH
50
B
S
 
 
ARRACK 
TREET
PO
B
269 
 
OX 
T
, NJ
08695‐0269
RENTON
 
______________________________________________________________________________________________
Signature of Officer
Title
Date
CBA-1 (03-10, R-4, ct)
Pg 2

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