CBA-1 
(03-10, R-4, ct) 
                                                                  STATE OF           NEW JERSEY     
                                                                  DIVISION OF        TAXATION       
                                                       NOTICE OF BUSINESS            ACTIVITIES        REPORT               
                                                          by   a FOREIGN CORPORATION                            
                                                              (Incorporated other than   in   New Jersey)     
                                                                    (P.L. 1973, c.   171)      

                                                               FOR CALENDAR          YEAR  ________            

      or taxable year beginning __________________________, ________ and ending __________________________, ________ 

DUE DATE:  File on or before the fifteenth day of the fourth month after the close of the calendar or fiscal year. 

      Name                                                                                        Federal Identification No.  

      Address (Number        and Street or   Rural Route)                                         State of   Incorporation 

      City, Town   or   Post Office and State                       Zip Code                      Date of   Incorporation

Principal Type of Business ___________________________________________________________________________________________________ 

Location of Principal Office __________________________________________________________________________________________________ 

Offices and Other Places of Business in New Jersey:  
Location                                                                                           Nature of Activity

________________________________________________________________                                  _____________________________________________ 
Officers, Employees, Agents and Representatives in New Jersey (attach fully descriptive 
duty statement for each officer and each class of employee, agent or representative) 
Title                                                                                              Number of Persons
_________________________________________________________________________                         ___________________________________________________
                                                                  GENERAL INFORMATION 

1. Chapter 171 Laws of 1973 (N.J.S.A. 14A:13-14, et seq.) provides that every foreign corporation except corporations exempt pursuant
      to paragraph 2, must file a Notice of Business Activities Report on Form CBA-1 if:

      (a) Such corporation has not obtained a certificate of authority to do business in New Jersey and is not "doing business" in this
                 State in the traditional franchise tax sense, but, nevertheless, is deriving income from sources within this State; or is engaged
                 in any type of activity or interrelationships within this State.
      (b) Such corporation disclaims liability for the Corporation Business Tax and any obligation to obtain a certificate of authority to
                 do business in this State.

2. A foreign corporation is exempt from the requirement of filing a Notice of Business Activities Report if:

      (a) By the end of its accounting period for the preceding calendar or fiscal year it had received a certificate of authority to do
                 business in New Jersey issued by the Division of Revenue;
                 or
      (b) Files a timely return under the Corporation Business Tax Act for such calendar or fiscal year.

      NOTE:    The failure of a foreign corporation to file a timely report may prevent the use of the courts in this State for all contracts 
                   executed and all causes of action that arose at any time prior to the end of the last accounting period for which the 
                   corporation failed to file a required timely report. 

                                                          ANSWER ALL QUESTIONS ON THIS FORM

Corporate Name _________________________________________________________________________ 

Federal ID# ________________________________________________           F/Y/E __________ / __________ / __________

Answer All Questions (See Instructions for Explanations): 

DID THIS CORPORATION, now or ever, conduct any of the following activities in New Jersey: 

        If "YES" insert first date (month and year) in yes box.                                                                YES                      NO 
        If  "NO" insert "X" in no box                                                                                           Month/Year               X 

1.     Conduct any type of activity or engage in any interrelationships within New Jersey? ............................ 
2.     Derive Income from sources located in New Jersey?
        If yes, specify:   Type ____________________ Approximate amount $_________________ ……….. 
3.     Solicit sales in New Jersey?  If yes, specify:

                           For product         By In-State Reps., etc.    Internet or Electronic Means 

                           For services        By mail or phone only .. …………………………....………… 
4.     If you have in-state solicitation of product is sales acceptance and/or approval:
                           By salesman at New Jersey customer 
                           At corporate office located outside of New Jersey …………………………………….……… 
5.     If you have in-state salespeople with in-home offices in New Jersey, do you reimburse them for the
       expense of maintaining such space in their home?  If yes, submit copies of  vouchers .........……….…. 
6.     Own, rent or lease any type of property located in New Jersey either for your own or other use? ..…… 

7.     Do you license the use of intangible rights to clients located in New Jersey? …………………………. 

8.     Provide any type of continuous maintenance program(s) which is/are performed in New Jersey by this
        entity or by any sub-contractor or independent contractor? .………………………………….……….. 

9. Deliver goods to points in New Jersey?              Your own trucks             Common Carrier
       If delivered in your own truck, do you assist in set-up, installation or pick up of damages, returned or
        replaced goods? …………………………………………………………………………………………. 

10.   Perform any type of service in New Jersey, not related to solicitation of sales? ...................................... 

11. Do you own or lease any vehicles which are registered in  New Jersey?  If yes, are they assigned to:
                           Salespeople only    Salespeople and others              Others ………………. 
12. Is this corporation deriving income as a partner/member of any Partnership or LLC located or doing
       business in New Jersey?  If yes, describe this corporation's involvement:

       ___________________________________________________________________________________
In conclusion, is this corporation otherwise subject to tax under either the Corporation Business Tax Act  
(N.J.S.A. 54:10A-1, et seq.) ……………………………………………………………………………………                                                                        YES                     NO 
    or 
have any obligation to obtain a certificate of authority to do business in this State. (as qualified and issued by 
the Division of Revenue, Commercial Recording Bureau …………………………………………………………                                                          YES                     NO 

CERTIFICATION OF AN AUTHORIZED OFFICER OF THE CORPORATION 
                                                                                                                                 SUBMIT COMPLETED FORM      
I hereby certify that this report, including any attachments, is to the best of my knowledge and belief, a true,                              TO: 
correct and complete report.                                                                                                  NJ D IVISION OF AXATION T   OFFICE 
                                                                                                                                   AUDIT RANCH B         
                                                                                                                              3 John Fitch Way 2nd Floor
                                                                                                                                   PO B       OX 269 
                                                                                                                              TRENTON,   NJ 08695 0269‐
______________________________________________________________________________________________ 
Signature of Officer                                          Title                                               Date 
  CBA-1 (03-10, R-4, ct)                                                                                                                                         Pg 2 

                                      CORPORATION BUSINESS                      ACTIVITIES         REPORTING          ACT         
                                                           INSTRUCTIONS (by              Question)            

   (1)       Includes the maintenance       of   an office or other    place of business;   maintenance         of personnel,    including the presence    
             of employees, agents,    representatives        or   independent contractors        in connection      with the corporation's     business, 
             even though not    regularly   stationed   in New   Jersey. 

   (2)       Receive payments from       persons,    business,   etc.  located   in New   Jersey   regardless    of any   other connection     with New       
             Jersey.

   (3)       Have customers located      in   New Jersey   from  which    you derive    sales receipts.      You must  indicate     whether for product      
             or services and   whether   solicitation   is physically   in state.  ‐

   (4)       Does the salesman      have this  authority   or are   orders   required   to be approved       at the corporation's    office out  of state.     

   (5)       Examples   of expenses include     (but   are not limited   to) mortgage      or rent,   electricity,  gas, oil, telephone,  other        
             utilities, travel and  entertainment.     Please   include     copies  of appropriate    expense      vouchers. 

   (6)       Examples   of corporate property       include   (but  are not limited    to) real  estate,  inventories,    office equipment,      office     
             space, storage space,    other    equipment,     etc. that  is used   by the   corporation   or that   is rented,   leased, etc. to others,    
             in which the corporation     retains   title. 

   (7)       Examples include (but    are   not limited    to) software     licensing  agreements     with end     users  in New Jersey;   the   use of        
             patents, trademarks, logos,       goodwill,   or   any other   items   that result  in the   payment   of royalties   and the location   of        
             franchises   in New Jersey. 

   (8)       Is there a   contractual obligation    to perform   continuing     maintenance        services?    You must  submit     copies of   said     
             agreements.

   (9)       If you deliver goods   (that you  sell), does   the corporation,      at point   of delivery,   perform  any other     services  that go         
             beyond merely     unloading    of   goods, merchandise       or inventory,    such  as set   up, installation‐  , moving,   etc. or picking    
             up damaged,    returned     or   replaced goods? 

   (10) Services include:      repairs,  maintenance,      construction,     installation,    supervision,      consulting,    technical assistance, 
             training, collection of   accounts, taking      inventory,   maintaining     displays,  conducting       meetings/seminars        (for other   
             than sales personnel),   transport     of   the goods  of others,   etc.   

   (11) If there are   corporate    owned   or leased   vehicles    in New   Jersey, answer accordingly.      

   (12) This must     be answered     if the   corporation   has a partnership      interest  in a partnership     or LLC doing   business  or              
             located   in New Jersey. In    addition, submit   a rider   detailing  the partnership     or LLC name    and     mailing address   as well        
             as same for  all   other partners. 

 The final two   (2) questions  dealing     with subjectivity    to Corporation       Tax and    the necessity   to qualify   as a Foreign     Corporation        
are   to be answered  to   the best ability of the   respondent.             

 Please note that     the Business    Activities Report    will be rejected  and returned        to the corporation    as unfiled   for the following            
reasons: 
                Calendar or   fiscal year  has not  yet ended 
                Report does not      include  calendar    or fiscal   year covered 
                Report covers a   period in   excess of one   year 
                Report has not     been signed 
                Federal Identification Number         is   missing
                Form   is incomplete (all  questions      must  be answered)  

 For further    information,   contact   the   Office Audit   Branch,   Nexus   Group,    phone     number             (609) 984-5749.