Enlarge image | AB AP-114 CD (Rev.4-21/19) PRINT FORM CLEAR FIELDS b Texas Nexus Questionnaire ACID Texas taxpayer number File number You have certain rights under Chapters 552 and 559, Government Code, to review, request and correct information we have on file about you. Contact us at the address or phone number listed on this form. 1. Entity name 2. Federal employer identification number (FEIN) 3. Mailing address (if different than above address) Street City State ZIP code 4a. Contact person 4b. Contact phone (Area code and number) 5a. Contact email 5b. Website address 6. Organization Structure Profit corporation (CF) General partnership (PB,PI) Limited partnership (PF) Professional corporation (CU) Professional association (AF) Real estate investment trust (TI) Nonprofit corporation (CM) Business association (AC) Joint venture (PW) Limited liability company (CI) Business trust (TF) Other month day year 7. In what state or country was this entity formed? Formation date 8. If this entity is registered with the Texas Secretary of State, please provide the file number. 9. Please provide the entity's North American Industry Classification System (NAICS) code. (NAICS codes are available at https://www.census.gov/eos/www/naics/) 10a. Please list any tax permits or licenses issued to this entity by the Texas Comptroller. Type of permit or license Taxpayer number for permit or license 10b. If included in a combined group Texas Franchise Tax Report, provide the reporting entity's Texas taxpayer number 11. Please describe this entity's business activities in Texas: 12. Please provide the earliest date this entity had a physical presence in Texas. Examples of Start Date month day year physical presence in Texas include but are not limited to the items below. See Rule 3.586 for further details. Check all that apply. Place of Business (maintaining a place of business, Loan Production Activities Solicitation (promote sales/service using manufacturing plant, office, warehouse or retail outlet, owned (solicit sales/loan contracts, gather data, make credit checks employees, independent contractors, agents or or leased) or other financial activities in Texas with own employees, other representatives) Real/Personal Property (hold, acquire, lease, install, independent contractors or agents) General Partner (in a general or limited erect, modify, maintain, repair or dispose of real or personal Delivery/Transportation (facilities, vehicles, partnership that is doing business in Texas) property used or located in Texas) employees, or representatives for transportation of passengers or property in Texas, including the service, Shows/Sporting Events (staging of Employees/Independent Representatives maintenance, and repair of vehicles or other equipment and or participation in shows, theatrical performances, (including temporary employees, contractors, agents) coordinating/directing the transportation of passengers sporting events ) Inventory/Storing Goods (including consigned goods) or property) Advertising (enter Texas to purchase, place Provide a Service (through employees, independent Perform a Contract (with own employees, local or display advertising for the benefit of another) contractors, agents or other representatives) labor or contractors) Federal Enclave (doing business in Texas even if the area is leased, owned or controlled by Holding Company (maintain place of business, Sell and License Software in Texas the federal government) manage, direct and/or perform services for subsidiaries Franchisor (contracts where a franchisee is granted the or related entities) right to engage in business under a marketing plan/system Warranty Work (with own employees or third party) Manufacturing/Shipping substantially prescribed by the franchisor or if franchisee's Manage or Operate Business from Texas business is substantially associated with the franchisor's brand service mark or other commercial symbol) |
Enlarge image | Form AP-114 (Back)(Rev.4-21/19) 13a. Will the entity exceed $500,000 in gross receipts from business done in Texas? Yes No Start Date 13b. If yes, please provide the start date of any federal income tax accounting period in which month day year gross receipts from business done in Texas exceeded $500,000. 14. If nexus ended, provide the reason and the last date of activity in Texas. Include home state documents if the entity ceased to exist. monthNexusdayend dateyear 15. Please complete this information for all members, all general partners and each limited partner with a 10% or more interest in the partnership. (For limited partnerships, general partnerships, joint ventures and joint stock companies.) (Attach additional sheets if necessary.) Name Type of owner FEIN Percentage of ownership Member GeneralPartner LimitedPartner % Mailing address City State ZIP code Begin date in Partnership Printed name Title AB Name Type of owner FEIN Percentage of ownership Member GeneralPartner LimitedPartner % Mailing address City State ZIP code Begin date in Partnership Printed name Title AB Name Type of owner FEIN Percentage of ownership Member GeneralPartner LimitedPartner % Mailing address City State ZIP code Begin date in Partnership Printed name Title AB I declare that the information in this document and any attachment is true and correct to the best of my knowledge and belief. Print preparer's name Title Phone (Area code and number) Date AB Information about franchise tax is available online at www.comptroller.texas.gov/taxes/franchise/. Please return this completed questionnaire to: For taxpayer assistance, call 800-252-1381 or 512-463-4600. Texas Comptroller of Public Accounts P.O. Box 149348 Austin, TX 78714-9348 |