Schedule N                                       Nexus – Immune Activity Declaration\
      (11-22)

       For tax year beginning                             ,      and ending                                 , 
Corporation Name                         Federal ID Number                             Unitary ID Number, if applicable
                                                                                       NU
                               Read the instructions before completing this schedule.
During the period covered by this return, was this corporation:
  Yes   No       (1)  A member of a combined group that files a New Jersey combined return?

Did this corporation (member), during the period covered by this return, perform any of the following activities in New Jersey:
  Yes   No       (2)  Own, lease, or rent any real property in New Jersey?

  Yes   No       (3)  Lease tangible property to others for use in New Jersey?

  Yes   No       (4)  Own or lease vehicles registered in New Jersey that are provided to people who are not sales people?

  Yes   No       (5)  Own, lease, or rent any type of property located in New Jersey (consignments, inventory, drop shipments, or 
                      like transactions)?
  Yes   No       (6)  License the use of any intangible rights from which royalties, licensing fees, etc., are derived from the use of 
                      these rights in New Jersey (e.g., without limitations, software licenses, trademarks)?
  Yes   No       (7)  Solicit in New Jersey for services through the use of employees, officers, agents, and/or independent con   -
                      tractors or representatives?
  Yes   No       (8)  Perform any type of service in New Jersey (other than solicitation) such as constructing, erecting, install-
                      ing, repairing, consulting, training, conducting seminars or meetings, or administering credit investigations 
                      through the use of employees, agents, subcontractors, and/or independent contractors or representatives?
  Yes   No       (9)  Provide any technical assistance or expertise that is performed in New Jersey through the use of employees, 
                      agents, subcontractors, and/or independent contractors or representatives?
  Yes   No       (10) Perform any detail work in New Jersey without limitations such as taking inventory, stocking shelves, main-
                      taining displays, arranging delivery through the use of employees, agents, subcontractors, and/or indepen-
                      dent contractors or representatives?
  Yes   No       (11) Carry goods, merchandise, inventory, or other property including samples into New Jersey for direct sale to 
                      customers in New Jersey?
  Yes   No       (12) Pick up and/or replace damaged, returned, or repossessed goods from New Jersey customers with 
                      company-owned vehicles or through contract carriers?
  Yes   No       (13) Pick up or deliver to points in New Jersey with company-owned vehicles or through contract carriers for any 
                      other company other than itself?
  Yes   No       (14) Provide any type of maintenance program that is performed in New Jersey by either this entity or an inde-
                      pendent contractor?
  Yes   No       (15) Have sales representatives who have the authority to accept or approve sales orders from customers lo-
                      cated in New Jersey in which acceptance/approval takes place in New Jersey and not from an out-of-State 
                      location?
  Yes   No       (16) Have employees, independent contractors, or representatives with in-home offices in New Jersey for which 
                      they are reimbursed for expenses other than telephone or travel or have employees working from home 
                      telecommuting on a regular basis for the convenience of the taxpayer?
  Yes   No       (17) Own an interest in either a partnership or LLC doing business in New Jersey? If yes, identify the name and 
                      address of the partnership or LLC.
  Yes   No       (18) Secure deposits for sales or payment for sales and/or deliveries?

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 Yes        No (19)   Allow catalog or online sales to be returned or picked up at an in-store location of a related or affiliated 
                      company?
 Yes        No (20)   Collect delinquent accounts directly or indirectly or repossess property?

 Yes        No (21)   Maintain a display at a single location for more than two weeks?

                     Affirmation of information by an officer/responsible individual
I hereby certify that this schedule, including any accompanying riders, is to the best of my knowledge a true, correct, and complete 
report.

Name:                                        Title:
Signature:                                   Date:

                     Questions or inquiries can be directed to the Nexus Audit Group at (609) 984-5749

                                    Purpose of Schedule
This schedule must be completed annually and be made part of the Corporation Business Tax return (Form CBT-100, 
CBT-100U, or CBT-100S) filed by any foreign corporation seeking to claim immunity from income taxation pursuant to 
Public Law 86-272, 73 Stat. 555, USC § 381 and pay the minimum tax prescribed under N.J.S.A. 54:10A-5(e). This schedule 
is not to be filed by corporations incorporated under the laws of the State of New Jersey. 

Instructions
1)  If the answer to any question is “Yes,” the corporation will be required to apportion net income to New Jersey and 
determine the amount of tax on its New Jersey corporation apportioned income. The corporation will pay this tax or the 
minimum tax, whichever is greater. 

2)  If the answers to all questions are “No,” this schedule can be included with the New Jersey Corporation Business Tax 
return to claim immunity from tax on its net income. The corporation will pay only the minimum tax.  

Corporations using this schedule must complete the New Jersey Corporation Business Tax return in full.

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