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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)



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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






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