Form C101 - Minnesota Business Activity Questionnaire Page 2
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58 Check the activities performed using vehicles owned or leased by the business.
Enter the years performed and frequency.
Deliver merchandise to Minnesota locations . . . . . Years
Frequency
Pick up own merchandise for return
to out-of-state locations . . . . . . . . . . . . . . . . . . . .
Years
Frequency
Pick up products owned by another business . . . . . Years
Frequency
Pick up merchandise from one Minnesota location
for delivery to another Minnesota location . . . . . . . Years
Frequency
Have vehicle drivers or passenger s make sales . . . Years
Frequency
9 Does your business own or lease terminals or fuel facilities in Minnesota? If yes, enter location . . . . . . . . . . .
Yes
No
10 Enter names, addresses and phone numbers of your three largest Minnesota customer s.
a.
b.
c.
11 Enter your Minnesota destination sales (sales, gross earnings or receipts) for each of the past three years.
yr
$
yr
$
yr
$
12 Enter your total company sales (sales, gross earnings or receipts) for each of the past three years.
yr
$
yr
$
yr
$
13 Enter your net income/ordinar y income (before net operating loss deduction) from your federal income tax
return for each of the past three years.
yr
$
yr
$
yr
$
Section B
1 Has your business at any time had an office, agency, warehouse or other place of business in Minnesota? . .
Yes
No
If yes, enter dates, location and nature of activities.
2 Has your business at any time owned, leased or rented the following tangible or real property located
and/or used in Minnesota?
a. Advertising materials . . . . . . . . . . .
Yes
No
g. Office equipment . . . . . . . . . . . . .
Yes
No
b. Industrial equipment . . . . . . . . . . . .
Yes
No
h. Office space . . . . . . . . . . . . . . . .
Yes
No
c. Leased equipment . . . . . . . . . . . . .
Yes
No
i. Raw materials . . . . . . . . . . . . . . .
Yes
No
d. Manuals . . . . . . . . . . . . . . . . . . . .
Yes
No
j. Software licenses . . . . . . . . . . . . .
Yes
No
e. Merchandise inventory . . . . . . . . . .
Yes
No
k. Warehouse spaces
. . . . . . . . . . .
Yes
No
f. Motor vehicles . . . . . . . . . . . . . . . .
Yes
No
l. Other
For items checked “yes,” enter the location, dates and description of the property. Attach additional sheets if necessar y.
3 Has your business ever done any advertising or promotional activities in Minnesota? . . . . . . . . . . . . . . . . . . .
Yes
No
If yes, describe activities, property used and media employed.
Continued
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Minnesota Business Activity Questionnaire
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Parent category: Financial