C101

Minnesota Business Activity  Questionnaire

Legal name of business                                                               Federal employer ID number (FEIN)                         Date income year ends

Home office mailing address                                                          Phone                                                     Fax

City                                                              State Zip code     Web address                                               Email address

Type of business                                                                     State/year  of incorporation or organization              Year of subchapter S election
 Corporation      S corporation         Partnership                Other
If S corporation or partnership, enter:
Number of shareholders or partners                                Percentage ownership of the partner/shareholder  owning the largest share                       %
Prior business  names and dates of incorporation or organization, if any

Principal product or service                                                         Brand names of products or services

States  or countries from where products/ser vices are marketed or shipped

Answer all questions  with regard to the business  listed above.  Attach  additional sheets  if necessary to explain your answers.
Enclose a copy of your most recent annual report.

Section  A
1    Check the tax types  for which your business  has filed a Minnesota  return. Enter the years filed and FEIN if different from above.
            Corporation  franchise  tax  . . . . . . . . . . From                 to       .  FEIN
            S corporation tax  . . . . . . . . . . . . . . . .    From            to       .  FEIN
            Partnership  tax  . . . . . . . . . . . . . . . . . . From            to       .  FEIN
            Sales/use  tax  . . . . . . . . . . . . . . . . . . From              to       .  FEIN
            Withholding  tax/unemployment tax  . . . From                         to       .  FEIN

2    Has  your business  made Minnesota  retail sales  of products  or services?  If yes, what types  of products
     or services  have you sold?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .          Yes   No

3    Does  your business  have a regional office serving Minnesota?  If yes, enter the office location  and the
     states  it serves  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    Yes   No
     Location                                                                        State(s) 

4    Is your business  listed  in a Minnesota  phone directory? If yes, enter city and phone number  . . . . . . . . . . . . .                                       Yes   No
     City                                                                            Phone 

5    Enter the date your business  began marketing or shipping  your products/ser vices  in Minnesota  . . . . . .                                                /      /

6    Does  your business  have a distribution  center located  in Minnesota?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                            Yes   No

7    Have products  been sent  to Minnesota  in returnable containers?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                            Yes   No
     If yes:
            a. Does  your business  retain ownership of the containers?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                       Yes   No
            b. Does  your business  charge a deposit  on the containers?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                        Yes   No
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(Rev.  /3 13)                                                                                                                         Minnesota  Business  Activity Questionnaire   1

8  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  customers.
   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.

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2  Minnesota  Business  Activity Questionnaire

4  Has  your business  leased  or licensed  real or tangible property to others in Minnesota?
   If yes, identify the property  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    . . . . . . . . . . . .        Yes  No

5  Has  your business  ever had consigned  goods  in Minnesota?  If yes, explain the circumstances  . . . . . . . . . . . .                                           Yes  No

6  Does  your business  ever execute  contracts  in Minnesota?  If yes, enter dates  and describe  contract(s)  . . . . . .                                           Yes  No

7  Did your business  retain a security  interest  in any property that was delivered to Minnesota  customers?
   If yes,  explain  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   . . . . . . . . . . . . . .    Yes  No

8  Did title to property located  in Minnesota  remain with the business  until the contract price was fully paid?  . . .                                             Yes  No
9  Has  your business  or an affiliated  business:
   a. Filed financing statements  with the Minnesota  Secretar y of State?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                              .  Yes  No
   b. Provided financing services  to Minnesota  customers?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                            Yes  No
10 Has  your business  sold  real estate, services  or intangibles  (including extended  warranty, maintenance
   or service/repair  agreements)  to Minnesota  customers?  If yes, enter date, location  and description
   of property/ser vices  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .         Yes  No

   a. Was on-site  warranty service provided?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                    Yes  No
   b. To whom do you refer your Minnesota  customers for servicing? Provide name, address  and phone number.

11 Do employees  in Minnesota  solicit  orders for the sales  of services  or real estate  in Minnesota?  If yes, explain.                                            Yes  No

12 Does  your business  perform non-solicitation  activities  in Minnesota?  If yes, explain  . . . . . . . . . . . . . . . . . . . .                                 Yes  No

13 Does  your business  conduct training in Minnesota  for customers, agents  or distributors, or for their
   customers or employees?  If yes, explain  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                    Yes  No

14 Does  your business  conduct lectures  in Minnesota  regarding its  products  or services?  If yes, explain  . . . . . . .                                         Yes  No

15 Does  your business  inspect  products  after installation?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . . . .                      Yes  No
16 Does  your business  offer technical  assistance  or training to purchasers or users of its  product
   after the sale?  If yes,  explain  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . . . . . . . .          Yes  No

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                                                                                                                                      Minnesota  Business  Activity Questionnaire   3

17 Does  your business  have resident  or nonresident  employees, sales  reps or commissioned  agents
   working in Minnesota?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      Yes  No
   If yes:
   a. Do you have standard  job descriptions  or written agreements  with the employees, sales  reps or
   commissioned  agents?  Enclose  a copy  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                 Yes  No
   b. Do the employees  reside  in Minnesota?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .             Yes  No
   c. Do you require employees  to:
   • Maintain office space  in their homes?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                 Yes  No
   • List  it as a business  address?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . . . .          Yes  No
   • Receive  business  callers there?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .            Yes  No
   • Store  inventory there?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   . . . . . . . . .      Yes  No
18 Does  your business  reimburse  office expenses?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                 Yes  No
19 Does  your business  have employees  who install  its  products  in Minnesota  or supervise  the installation
   by others in Minnesota?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     . . . . . . . . . . .  Yes  No
20 Do you have anyone acting on the business’s behalf who repairs its  products  in Minnesota?  . . . . . . . . . . . . .                                      Yes  No
21 Do employees  in Minnesota  investigate, recommend  or appoint potential  dealers,
   agents  or distributors?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   Yes  No
22 Does  anyone acting on your business’s behalf repossess  products  in Minnesota?  . . . . . . . . . . . . . . . . . . . . .                                 Yes  No

Section C—Other  activities  performed by employees, affiliates or others
1  Check the activities  that resident  or nonresident  employees  perform in Minnesota  (check all that apply):
   Maintain samples.  Enter value of samples  and explain what is done with them.

   Make “on-the-spot”  sales  of any items.
   Secure  deposits  on sales,  merchandise  or services  in Minnesota.
   Convey information concerning out-of-stock  or shipping  delays.
   Check  inventories  of customers or distributors in Minnesota.
   Remove obsolete,  damaged or outdated  inventories.
   Pick-up or verify destruction of damaged, returned or outdated  merchandise  in Minnesota.
   Carry complaint  forms that are completed  by the employee and forwarded to the proper
   location  for processing . If checked, provide a copy of form.
   Process  customer  complaints  in Minnesota.
   Authorize  credits, warranty adjustments  or repairs.
   Engage in any collection  activity of any kind in Minnesota.
   Make credit investigations  in Minnesota.

2  Does  any employee  within Minnesota  supervise  or manage other employees, independent  contractors
   or affiliates  who perform non-sales  activities  in Minnesota?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . . . .                 Yes  No
   If yes, enter job title and percentage  of time devoted to managing non-sales  activities.
   Attach a copy of the position  description.
   Job title 

Section  D—Independent  contractors
1  Does  your business  hire independent  contractors, agents, dealers, affiliates  or franchisees  to perform
   any activity in Minnesota?  If yes, describe  activities, and provide names  and address  of the parties.
   Also, provide copies  of agreements  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    . . . . . . . . .       Yes  No

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4  Minnesota  Business  Activity Questionnaire

2 Do you require independent  contractors, agents, affiliates  or dealers to refrain
  from representing  products  other than yours?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Yes  No
3 Do you require independent  contractors, agents, affiliates  or dealers to
  perform any of the activities  in this  questionnaire  for your business?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .         Yes  No

Section  E—Affiliated  companies
1 Does  your business  own more than 50 percent of another business?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                Yes  No
2 Does  another business  own more than 50 percent of your business?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                Yes  No
  If yes to either question  1 or 2, list  the names,  addresses  and FEINs of the businesses.

3 Check  all activities  that affiliated  companies  perform.
  File income tax in Minnesota.                                    Have destination  sales  in, or receipts  from, Minnesota.
  File sales  tax in Minnesota.                                    Solicit, distribute  or service products  in Minnesota  of
  File withholding (payroll) tax in Minnesota.                     other members of affiliated  group.
  Make mail-order sales  to Minnesota  customers.                  Perform services  or provide facilities  for affiliated  companies
                                                                   in Minnesota.
  For those  checked above, list  the affiliated  company, its  Minnesota  tax ID number, activity, dates  and locations.
  Attach  additional  sheets  if necessar y.

Check  this list before mailing. Have you included:
  Any additional  information  requested?
  A copy of your most  recent annual report?
  Job descriptions?
  Product brochures?
  Independent  contractor  agreements?
  Affiliation  information?

  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 necessar y.

Sign here
I declare that the information furnished in this report, 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

                                                                                              Minnesota  Business  Activity Questionnaire   5