Fillable Printable Nexus Questionnaire -Utah
Fillable Printable Nexus Questionnaire -Utah
Nexus Questionnaire -Utah
Utah State Tax Commission
210 N 1950 W • SLC, UT 84134 • www.tax.utah.gov
Nexus Questionnaire
Company Information
Exact business name
Federal ID number
Street address of principal office
Contact person
City
State
Zip code
Contact phone number
Type of business
Corporation
Sole Proprietor
L.L.C.
Partnership
Other:
_________________________________
First date that business in Utah began, or that
If no longer doing business within Utah,
income was derived from sources within Utah:
_______________________________
indicate date business activity ceased:
_______________________________
Nature of business and description of property and/or services sold. Attach additional sheets if necessary.
Who are the company's customers? (check all that apply)
Resellers
Final consumers
Do you now or have you ever filed Utah Corporation Franchise/Income Tax Returns? If yes, complete (a), (b) and (c) below.
Yes
No
(a)
Date first return filed:
_____________________________
(b)
Date last return filed:
_____________________________
(c)
Business name under which last return was filed:
___________________________________________________________________________________________
What was the company's total sales to customers in Utah and the total sales to all customers during the last three (3) years?
Year Utah Sales Total Sales
_______________ $__________________ $__________________
_______________ $__________________ $__________________
_______________ $__________________ $__________________
Nexus Questions
Answer "Yes" or "No" to the following questions. For answers that require additional information, include that information on a separate sheet, and
reference the question number.
1. Does the company have an office, agency, warehouse or other place of business in Utah? If YES, list company name,
...............
Yes
No
location and nature of activities on a separate sheet.
2. Does the company regularly solicit orders in Utah, whether or not those orders are accepted in Utah?
.........................................
Yes
No
3. Does the company hold title to tangible personal or real property located in Utah, i.e., merchandise inventory, motor
..................
Yes
No
vehicles, office or industrial equipment, etc.? If YES, list owner, location and description of such property on a
separate sheet.
4. Does the company rent or lease to others or has it at any time in the last three (3) years rented/leased property to
.....................
Yes
No
others who then use the property in Utah? If YES, list lessee's name, location and description of property on a
separate sheet.
5. Does the company rent or lease from others or has it at any time leased or rented from others any tangible personal
.................
Yes
No
property located and/or used in Utah, i.e., warehouse space, motor vehicles, office space, housing space or
industrial equipment, etc.?
6. Does the company have a Utah telephone number or use a Utah answering service?
...................................................................
Yes
No
7. Does the company have or has it at any time maintained or consigned stocks or goods in Utah (i.e. distribution
..........................
Yes
No
warehouse)?
8. Does the company deliver to a Utah location by using company owned or leased vehicles?
..........................................................
Yes
No
9. Are contracts or similar agreements executed in Utah?
...................................................................................................................
Yes
No
TC-51
Rev. 9/02
Who are the company's customers? (check all that apply)
Who are the company's customers? (check all that apply)
10. Does the company engage in any activity in connection with the leasing or servicing of property located in Utah?
.......................
Yes
No
11. Does the company have or has it ever had a security interest in any real or personal property sold or located in Utah?
...............
Yes
No
12. Does the company have any employees, commissioned agents, independent contractors or other representatives
.....................
Yes
No
residing, selling, soliciting or performing services in Utah? If YES, list on a separate sheet the year(s) in which your
employees or other representatives began performance of these activities in Utah.
Employee and Contract Agent Information
Employee and Contract Agent Information
The following questions pertain to the type of activities performed by the employees or independent contract agent(s) within Utah.
13. Does the company have any employees, sales representatives, commission agents or independent contractors
that carry out or that are responsible for any of the following activities in Utah?
a. Making repairs or providing maintenance
................................................................................................................................
Yes
No
b. Collecting delinquent accounts
................................................................................................................................................
Yes
No
c. Investigating credit worthiness
.................................................................................................................................................
Yes
No
d. Installing or supervision of installation
.....................................................................................................................................
Yes
No
e. Conducting training courses, seminars or lectures
..................................................................................................................
Yes
No
f. Providing any kind of technical assistance or service when a purpose of that assistance or service is something
................
Yes
No
other than the facilitation or solicitation of orders
g. Handling customer complaints
................................................................................................................................................
Yes
No
h. Approving or accepting orders
................................................................................................................................................
Yes
No
i. Repossessing property
............................................................................................................................................................
Yes
No
j. Securing deposits on sales
......................................................................................................................................................
Yes
No
k. Picking up or replacing damaged or returned property
............................................................................................................
Yes
No
l. Hiring, training or supervising personnel, other than personnel involved only in solicitation
...................................................
Yes
No
m. Using agency stock checks or any other instrument by which sales are made within Utah by sales personnel
.....................
Yes
No
n. Maintaining sample or display room in excess of two weeks (14 days) during the year
..........................................................
Yes
No
o. Carrying samples for sale, exchange or distribution in any manner for consideration or other value
.....................................
Yes
No
p. Consigning tangible personal property to any person, including an independent contractor
..................................................
Yes
No
q. Owning, leasing, maintaining or otherwise using any of the following facilities or property in state of Utah
1. Repair shop
.....................................................................................................................................................................
Yes
No
2. Parts department
.............................................................................................................................................................
Yes
No
3. Any kind of office other than an in-home office
................................................................................................................
Yes
No
4. Warehouse
......................................................................................................................................................................
Yes
No
5. Meeting place for directors, officers or employees
..........................................................................................................
Yes
No
6. Stock of goods
.................................................................................................................................................................
Yes
No
7. Telephone answering service
..........................................................................................................................................
Yes
No
8. Mobile stores, i.e., trucks with driver salesmen
...............................................................................................................
Yes
No
9. Real property or fixtures of any kind
................................................................................................................................
Yes
No
r. Maintaining, by either an in-state or an out-of-state resident employee, an office or place of business of any
.......................
Yes
No
kind other than an in-home office
s. Entering into franchising or licensing agreements
...................................................................................................................
Yes
No
t. Shipping or delivering goods into Utah by means of private vehicle, rail, air or other carrier
..................................................
Yes
No
14. Does the company have a standard form or written agreement with employees, sales representatives, commissioned
................
Yes
No
agents or independent contractors? If YES, enclose a sample copy.
15. Are commissioned agents/independent contractors forbidden (by contractual agreement or otherwise) from selling or
................
Yes
No
promoting your competitors' products?
16. List names and addresses of employees or representatives, the territory they cover, and designate whether they are employees or independent
contractors. Use additional sheets if necessary.
17.
Do any of the sales agents in Utah represent your corporation only?
.............................................................................................
Yes
No
Other Information
Other Information
18. List the company's three (3) major Utah customers:
19. Are there other types of activities in Utah? Please explain:
Signatures
Signatures
Under penalties of perjury, I declare that the information furnished in this questionnaire is, to the best of my knowledge and belief, true, correct and
complete. If prepared by a person other than an officer of this corporation, this declaration is based on all information of which you have knowledge.
Name of officer
Title of officer
Signature of officer
Date
Officer's mailing address
City
State
Zip code
Officer's phone number
Name of preparer
Signature of preparer
Date
Preparer's mailing address
City
State
Zip code
Preparer's phone number
