(TR) 12-20 (FI)

                           REV-203D
                                                                           BUSINESS ACTIVITIES 
                                                                               QUESTIONNAIRE

      BUSINESS ACTIVITIES THAT CREATE NEXUS IN PENNSYLVANIA:                       ACTIVITIES THAT MAY CREATE NEXUS IN PENNSYLVANIA FOR 
      ●     Owning or leasing property                                             MOTOR CARRIERS FOR CORPORATION TAXES: 
      ●     Maintaining inventory within the commonwealth                          A truck or bus company is required to file a corporate net income tax report if 
      ●     Having employees or others soliciting sales or referring customers     its activities during the taxable year exceed either of the 
      ●     Delivering property into the commonwealth                              following standards: 
      ●     Maintaining a fixed location                                           (a) Activity exceeds 50,000 loaded miles in Pennsylvania and the compa-
      ●     Installing or repairing of property by employees, independent contrac-     ny makes at least one trip with pickups or deliveries in Pennsylvania; or
            tors or others                                                         (b) The company has a Pennsylvania apportionment fraction of more than
      ●     Employee leasing services or personnel services                            5 percent and has more than 12 trips with pickups or deliveries in
      ●     Approving or accepting purchase orders                                     Pennsylvania.
      ●     Performing services, managerial or research activities
      ●     Repossessing property                                                  ACTIVITIES THAT MAY REPRESENT A DE MINIMIS PRESENCE IN 
      ●     Having one or more employees performing business activities in         PENNSYLVANIA FOR CORPORATE NET INCOME TAX: 
            Pennsylvania, even occasionally                                        Certain activities may be considered de minimis for purposes of filing a cor-
      ●     Conducting training or seminars                                        poration tax return as long as activity does not exceed seven days and the 
      ●     Providing transportation services                                      revenue from all such activities does not exceed $10,000. 
      ●     Hiring, training or supervising personnel                              For more details, consult Corporation Tax Bulletin 2004-01, Application of PL 
      ●     Economic Presence; $100,000 or more in gross sale - subject to Sales   86-272 and De Minimis Standards, available at www.revenue.pa.gov.
            Tax; $500,000 or more in gross sales - subject to Corporate Tax

      Instructions: Complete all sections of this form. Email the completed and signed form to rv-ra-brtm-discovery@pa.gov.

      SECTION I               GENERAL INFORMATION
START  1a. Legal Name
Ü
       1b. Doing Business As                                                                                       2. Federal EIN

      3.Address

       City                                                                                   State                 ZIP Code

      4.Type of Business Entity (Select One)
            Corporation                                                                Partnership (attach a copy of the first page of your federal 
                                                                                       corporation or partnership filing) 
            Nonprofit  
            (If you are a nonprofit entity, attach a copy of the                       Individual (Proprietorship) 
            IRS letter granting you 501 status, if applicable.) 
                                                                                       Trust 
            Subchapter S Corporation 
                                                                                       Business Trust 
            Limited Liability Company 
                                                                                       Association 
            Restricted Professional Company

      5. If the entity is not a corporation, select one of the ovals below to indicate its IRS classification:
            As a corporation                                                           As a disregarded entity
            As a partnership (attach a copy of the first page of 
            your federal corporation or partnership filing) 

      6.The entity was formed                                     under the laws of

      7.The entity’s Pennsylvania Revenue ID Number is:

      8.The entity files federal returns on a tax year ending                                                 basis.

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                   REV-203D (TR) 12-20 (FI)

SECTION I           GENERAL INFORMATION cont.
 9. Other states this company conducts business in:

 10. Identify names, addresses and federal ID numbers of corporations that are shareholders of your subchapter S corporation(s) or 
that are members of your LLC/entity. If more space is needed, attach a list.
 Legal Name

 Doing Business As                                                                        Federal EIN

 Address

 City                                                                              State  ZIP Code

 Legal Name

 Doing Business As                                                                        Federal EIN

 Address

 City                                                                              State  ZIP Code

 Legal Name

 Doing Business As                                                                        Federal EIN

 Address

 City                                                                              State  ZIP Code

 11. If this company has registered with the PA Department of State, provide the entity number assigned by the 
Department of State:
 12. Enter the entity’s Pennsylvania Sales & Use Tax License Number:

 13. Enter the entity’s Unemployment Compensation Account Number:

 14. Describe activities performed in Pennsylvania by employees for whom unemployment compensation contributions are remitted 
to Pennsylvania:

SECTION II          PENNSYLVANIA BUSINESS ACTIVITIES – PART I
 1. Describe the principal business activities of the entity in Pennsylvania:

 2. Describe the principal business activities of the entity elsewhere:

 3. Indicate the date that the entity's activities in Pennsylvania first occurred:

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                     REV-203D (TR) 12-20 (FI)

SECTION II            PENNSYLVANIA BUSINESS ACTIVITIES – PART I cont.
4. Indicate primary North American Industry Classification (NAICS) Code

CUSTOMER SERVICE AND DELIVERY
1. Select the different ways in which the entity’s personal property is delivered in Pennsylvania:
       Motor carrier            U.S. mail       Your agent               Company vehicle             Other (Explain)
2. Select the different media you use to reach Pennsylvania customers:
       Internet       Telephone solicitations                    Catalogs placed in outlets            Other (Explain)
3. Does this entity participate in trade shows or fairs in Pennsylvania? If so, are products sold directly to the customers or are orders
taken and sent back to the home office for approval?

MOTOR CARRIER ACTIVITY
1. Is your company a motor carrier?           Yes              No
If the answer to this question is yes, complete all sections including Pennsylvania Motor Carrier Activities in Section IV.

SECTION II            PENNSYLVANIA BUSINESS ACTIVITIES – PART II
1. Complete the table below detailing the indicated activities:

                                                                            AMOUNT OF                                 DATE FIRST 
                                                                            DAYS         TOTAL INCOME                 PERFORMED 
                      BUSINESS ACTIVITY                                     PERFORMED IN DERIVED FROM                 IN PA 
                                                                            LATEST 12    THE ACTIVITY
                                                                            MONTH PERIOD                              (MM/DD/YYYY)
  Occasionally or regularly visits Pennsylvania to create a demand for 
  your personal property or service   

  Solicits sales of tangible personal property  

  Conducts installation activities for which a separate charge is made  

  Conducts repair, maintenance and service activities   

  Provides technical assistance or service activities, including but not 
  limited to engineering assistance or design service   

  Conducts training of your sales agents and distributors in Pennsylvania 

  Provides training courses, seminars or lectures by the vendor which  
  is incidental to the use of personal property sold by him to persons in 
  this commonwealth   

  Attends organized shows or flea markets for the purpose of 
  exhibiting goods   

  Total any additional revenues earned in Pennsylvania not identified above.

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                  REV-203D (TR) 12-20 (FI)

 SECTION II        PENNSYLVANIA BUSINESS ACTIVITIES – PART II cont.
2. Complete the following schedule for all tangible property located in Pennsylvania:

      VALUE OF ALL PROPERTY OWNED IN PENNSYLVANIA                                     VALUE OF PROPERTY UNDER LEASE IN PENNSYLVANIA 
 YEAR                                                                                              (AS A LESSOR OR LESSEE)

  20         $                                                                        $ 

  20          $                                                                       $ 

  20          $                                                                       $ 

  20          $                                                                       $ 

3. Complete the following schedule with respect to all                             4. Complete the following schedule with respect to
   Pennsylvania employees:                                                            Pennsylvania sales. (This includes sales of intangibles, sales
                                                                                      of services, and sales of tangible property.)
                  TOTAL ANNUAL WAGES PAID TO EMPLOYEES 
 YEAR             WHO WORK TOTALLY OR PARTIALLY                                    YEAR            TOTAL OF ALL SALES IN PENNSYLVANIA
                  IN PENNSYLVANIA

  20          $                                                                      20          $ 

  20          $                                                                      20          $ 

  20          $                                                                      20          $ 

  20          $                                                                      20          $

Answer the following questions in this section based on the entity’s activities in Pennsylvania. If the business is a corporation, 
responses should also reflect the activities of a partnership or similar association in which the corporation has an interest. 
Is your company licensed, registered, authorized or certified to do business in Pennsylvania?      Yes                            No

If the answer to the question above is yes and this company has already been provided tax identification numbers, list all other taxes 
and tax ID numbers not listed above under which the entity remits taxes to Pennsylvania:

(a)Tax Type                      Tax #                                             (b)Tax Type     Tax #
                                              If more space is needed, attach a list.
Property and other investments in Pennsylvania.                                    6.  Own other tangible property? . . . . . . . . . . .      Yes         No 
Does this entity:                                                                  6A. Own other tangible property i.e. aircraft, 
1. Own real estate?  . . . . . . . . . . . . . . . . . . . .      Yes         No       watercraft? . . . . . . . . . . . . . . . . . . . . . . . . .      Yes         No 
2. Store inventory in its own or                                                   7.  Lease (as lessee) tangible property? . . . . .      Yes         No 
   another’s facility? . . . . . . . . . . . . . . . . . . . .      Yes         No 
                                                                                   8.  Lease (as lessor) tangible property? . . . . .      Yes         No 
3. Consign goods to vendors, independent
   contractors or others?  . . . . . . . . . . . . . . . .      Yes         No     9.  Operate a mobile store?  . . . . . . . . . . . . . .      Yes         No 
4. Own display racks?  . . . . . . . . . . . . . . . . . .      Yes         No     10. Own an interest in an entity or person that
                                                                                       does business in Pennsylvania, and that
5. Own tooling, molds, dies, etc., located at                                          entity or person is not taxable as a
   a manufacturing facility?  . . . . . . . . . . . . . .      Yes         No          corporation for federal tax purposes?  . . . .      Yes         No 

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                  REV-203D (TR) 12-20 (FI)

SECTION II         PENNSYLVANIA BUSINESS ACTIVITIES – PART II cont.
Employee or representative activity in Pennsylvania.                                   28. Hire, train or supervise personnel?  . . . . . .      Yes         No 
Does this entity perform any of the following activities by                                Is this limited to personnel involved  
employees, agents, independent contractors or others                                       in the solicitation of sales of tangible 
in Pennsylvania?                                                                           personal property? . . . . . . . . . . . . . . . . . . .      Yes         No 
11. Solicit sales (including exhibition                                                29. Pickup or replace damaged or
    at trade shows)?  . . . . . . . . . . . . . . . . . . . .      Yes         No          returned property? . . . . . . . . . . . . . . . . . . .      Yes         No 
12. Enter into agreements with in-state                                                30. Maintain an office as lessee or owner of
    businesses, organizations or individuals                                               the office location? . . . . . . . . . . . . . . . . . . .      Yes         No 
    to refer potential customers? . . . . . . . . . . .      Yes         No 
                                                                                       31. Maintain a sample or display room?    . . . .      Yes         No 
13. Accept orders that are shipped to                                                      Is one maintained for more than 14 days 
    Pennsylvania customers from a                                                          during a tax year?  . . . . . . . . . . . . . . . . . . .      Yes         No 
    Pennsylvania location by any affiliate,
    agent or contractor? . . . . . . . . . . . . . . . . . .      Yes         No       32. Carry samples from which sales, exchanges
                                                                                           or distributions are made for consideration?  .      Yes         No 
14. Approve sales (including tangible
    and intangible assets)?  . . . . . . . . . . . . . . .      Yes         No         33. Maintain an office? . . . . . . . . . . . . . . . . . . .      Yes         No 
15. Provide a service (including consulting)?  .      Yes         No                       Is this limited to an in-home office that is 
                                                                                           not attributed to the company and that is 
16. Commit to onsite repair and/or                                                         used solely in connection with the 
    maintenance through warranty or sale                                                   solicitation of the sales of tangible 
    of service agreements?  . . . . . . . . . . . . . . .      Yes         No              personal property? . . . . . . . . . . . . . . . . . . .      Yes         No 
17. Solicit, negotiate or enter into franchising,                                      34. Lease employees? . . . . . . . . . . . . . . . . . . .      Yes         No 
    licensing or similar agreements? . . . . . . . .      Yes         No 
                                                                                       35. Maintain a telephone answering service?  .      Yes         No 
18. Operate mobile stores i.e. vehicles with
    drivers who are sales personnel making                                             36. Inspect customer installation of
    sales from said vehicles? . . . . . . . . . . . . . .      Yes         No              company’s product? . . . . . . . . . . . . . . . . . .      Yes         No 
19. Make repairs or provide maintenance to                                             37. Provide services to a
    property sold or to be sold? . . . . . . . . . . . .      Yes         No               Pennsylvania franchisee?  . . . . . . . . . . . . .      Yes         No 
20. Collect current or delinquent accounts?  . .      Yes         No                   38. Execute contracts? . . . . . . . . . . . . . . . . . . .      Yes         No 
21. Perform site visits or supervise or inspect                                        39. Foreclose on real estate?  . . . . . . . . . . . . .      Yes         No 
    installations at suppliers' or                                                     40. Make loans secured by Pennsylvania
    others' locations? . . . . . . . . . . . . . . . . . . . .      Yes         No         real estate?  . . . . . . . . . . . . . . . . . . . . . . . .      Yes         No 
22. Repossess property? . . . . . . . . . . . . . . . . .      Yes         No          41. Hold titles to property until the contract
23. Investigate credit worthiness of customers?       Yes         No                       price has been paid? . . . . . . . . . . . . . . . . .      Yes         No 
24. Secure deposits on sales? . . . . . . . . . . . . .      Yes         No            42. Ship products by returnable containers? . .      Yes         No 
25. Conduct training courses, seminars                                                 43. Deliver products in vehicles owned by
    or lectures?  . . . . . . . . . . . . . . . . . . . . . . . .      Yes         No      your company or by someone other than
                                                                                           a common carrier which is not affiliated
    Is this limited to individuals soliciting                                              by ownership interest in your company? . .      Yes         No 
    sales of tangible personal property?  . . . . .      Yes         No 
                                                                                       44. Sell new tires for motor vehicles?  . . . . . . .      Yes         No 
26. Provide technical assistance or service? . .      Yes         No 
    Is this limited to the facilitation of the                                         45. Lease or rent motor vehicles? . . . . . . . . . .      Yes         No
    solicitation of sales of tangible personal
    property?  . . . . . . . . . . . . . . . . . . . . . . . . . .      Yes         No 
27. Handle customer complaints?  . . . . . . . . . .      Yes         No 
    Is this limited to mediating complaints 
    when the sole purpose is to ingratiate 
    tangible personal property sales 
    personnel with the customer?  . . . . . . . . . .      Yes         No 

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                  REV-203D (TR) 12-20 (FI)

 SECTION III       INDEPENDENT REPRESENTATIVES
Are you a manufacturer’s representative? . . . . . .       Yes No
If you are a manufacturer’s representative, attach a list of the names and addresses of each business entity you represent in 
Pennsylvania.
If you have a contract with a manufacturer’s representative(s) to market your product or service to Pennsylvania customers, attach a 
list of the name(s) and address(es) of each.

 SECTION IV        PENNSYLVANIA MOTOR CARRIER ACTIVITIES
 1. Is your company a (Select all that apply)
        Common Carrier             Contract Carrier             Private Carrier            Lessor or motor vehicles to other trucking companies
                                                                                 (attach a copy of the lease agreement(s))
 2. Does your company deliver goods, passengers, products or commodities to destinations in Pennsylvania? . . . .       Yes                                          No
  2a. If your answer is yes, indicate when this activity began (month/year)
  2b. How often are deliveries made to Pennsylvania?
                  times per week;                            times per month; or    times per year

 3. Does your company pickup goods, passengers, products or commodities at locations in Pennsylvania?  . . . . . .       Yes                                         No
  3a. If your answer is yes, indicate when this activity began (month/year)
  3b. How often are pickups made to Pennsylvania?
                  times per week;                            times per month; or    times per year
 4. Does your company haul goods, passengers, products or commodities from one location in Pennsylvania to
 another location in Pennsylvania? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .       Yes No
 5. What percentage of your business (loaded mileage) is in Pennsylvania?
If your company is a private carrier, attach a list of related companies (parent, affiliate and subsidiaries).
                  Attach copies of your IFTA quarterly tax returns showing your Pennsylvania miles for the past four years.
 SECTION V         AFFIRMATION
I hereby affirm under penalties prescribed by law that this questionnaire has been examined by me, and to the best of my knowledge 
and belief is true, correct and complete. If prepared by a person other than the taxpayer, statements are based on all information of 
which preparer has knowledge. The preparer also must complete the information below:
 Print Name of Owner/Officer/Partner/other Responsible Party    Signature                                      Date
                                                                           Please sign after printing.
 Title                   Company Email Address                  Company Website (if applicable)                Telephone Number

 Print Name of Preparer                                         Signature                                      Date
                                                                           Please sign after printing.
 Title                   Email Address                                                                         Telephone Number

       Attach additional information to this questionnaire, if it is required to explain your business activities in Pennsylvania.

EMAIL COMPLETED FORM TO: RA-RV-BRTM-DISCOVERY@PA.GOV 
OR, FAX COMPLETED FORM TO: (717) 425-2952

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