Form C102 - Minnesota Service Activity Questionnaire Page 3
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1
2
3Minnesota Service Activity Questionnaire
C102
(pg. 3)
Yes
No
2. Has your business ever had others conduct business activities in Minnesota on your behalf?
If yes, check those that apply.
a. Resident employees
Yes
No
h. Non resident employees
Yes
No
b. Independent representatives
Yes
No
i. Distributors
Yes
No
c. Agents
Yes
No
j. Dealers
Yes
No
d. Franchisees
Yes
No
k. Other affiliates
Yes
No
3. Approximately how many days per year are your employees or representatives physically present in Minnesota? _______________
Affiliated Companies
1. Does your business own more than 50 percent of another business?
If yes, list the names, addresses, and FEINs.
2. Do any affiliated companies own more than 50 percent of your business?
If yes, list the names, addresses, and FEINs.
3. Check all activities that your affiliated companies perform.
File income tax in Minnesota
File sales tax in Minnesota
File withholding in Minnesota
Perform services for affiliate companies in Minnesota
4. For those checked above, list the affiliated company, its Minnesota tax ID number, dates and locations.
Attach additional sheets if necessary.
If you have other information that may be useful in determining if your business has a filing requirement for any tax in Minnesota,
include it here. Attach additional sheets if necessary.
I declare that the information furnished in this questionnaire, including accompanying statements, contracts and schedules, is to the
best of my knowledge and belief, true, correct, and complete.
Signature
Date
Name of Person who Prepared Questionnaire
Title
Daytime Phone
Mail to: Minnesota Revenue, Corporate Franchise Tax, 230 1st St. S., Suite 102, Virginia, MN 55792-2672. Phone: 218-735-3145
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