Texas Form Ap 114 – Fill Out and Use This PDF

AP-114 (Rev.10-01/13)

TEXAS NEXUS QUESTIONNAIRE

Under Ch. 559, Government Code, you are entitled to review, request, and correct information we have on file about you, with limited exceptions in accordance with Ch. 552, Government Code. To request information for review or to request error correction, contact us at the address or toll-free number listed on this form.

	1. Entity legal name and mailing address		INTERNAL US E ONLY
		Job type:	MI SCAPP		T code: 0 0 9 9 1
		Taxpayer number:
		Tax type and reason code:			1 3 2 4
		Reference number:
		File number:
	2A. If the information printed above is incorrect, enter the correct information.

2B. Business name ("Doing Business As" or "DBA")

4. Type of business (If "D" is checked, attach a list of general partners, names, FEIN, and addresses.)

A. Corporation

B. Limited Liability Company

C. Sole Proprietorship

D. Partnership

E. Other

5A. State of formation

5B. Date of formation

5C. Has the entity been involved in a merger within the last seven years?

5D. Accounting year end

(Attach a detailed explanation.)

YES

NO

7. Briefly describe the entity's business activities in Texas.

SIC code

8. Contact person and mailing address	9. Daytime phone (Area code and number)
	10.	E-mail address
	11.	Web site address
12. Check the items you have located in Texas.

ANS WER THE QUES TIONS BELOW AS THEY PERTAIN TO THE LAS T 7 YEARS .

13. Does the entity do any of the following in Texas (If "YES," indicate beginning date.)	YES			NO		Date
A. solicitation: have employees, independent contractors, agents, or other representatives in Texas to
promote or induce sales of the entity's goods or services;

B.services:

1.provide any service in Texas (regardless of whether the employees, independent contractors,

agents, or other representatives performing the services reside, have a home office or have a place of business in Texas);

2. install, erect, modify, maintain, or repair real or personal property in Texas; or

3. do warranty work in Texas, regardless of whether such warranty work is done by a third party.

C. place of business: maintain a place of business in Texas;

Form AP-114 (Back)(Rev.10-01/13)

YES NO Date

13.(Continued)

D. partners: act as a general partner in a general or limited partnership which is doing business in Texas;

E. contracting: perform a contract in Texas regardless of whether the entity brings its own employees into the state, hires local labor, or subcontracts with another;

F. inventory: have inventory in Texas;

G. real estate: hold, acquire, lease, or dispose of any property located in Texas;

H. shows: the staging of shows or other events in Texas;

I.transportation:

1. carry passengers or property in Texas if both pickup and delivery occur within Texas; or

2.have facilities and/or employees, independent contractors, agents, or other representatives in Texas for storage, delivery, or shipment of goods; for servicing, maintaining, or repairing of vehicles or other

equipment; for coordinating and directing the transportation of passengers or property; or for doing other business of the corporation/LLC;

J. franchisers: enter into one or more contracts with persons or other business entities located in Texas, by which:

1. the franchisee is granted the right to engage in the business of offering, selling, or distributing goods or services under a marketing plan or system prescribed in substantial part by the franchiser; and

2.the operation of a franchisee's business pursuant to such plan is substantially associated with the franchiser's trademark, service mark, trade name, logotype, advertising, or other commercial symbol

designating the franchiser or its affiliate;

K. processing: assemble, process, manufacture, or store goods in Texas;

L. advertising: enter Texas to purchase, place, or display advertising when the advertising is for the benefit of another;

M. processing and shipment: send materials to a Texas manufacturer, processor, repairer, or printer to be processed and stored in completed form awaiting orders for their shipment;

N. loan production activities: solicit sales contracts or loans, gather financial data, make credit checks, or perform other financial activities in Texas through employees, independent contractors, agents, or other representatives;

O. holding companies: maintain a place of business in Texas or manage direct, and/or perform services in Texas for subsidiaries or investee corporations/LLCs;

P. federal enclaves: do business in any area within Texas, even if the area is leased by, owned by, ceded to, or under the control of the federal government;

Q. consignments: have consigned goods in Texas;

R. delivering: deliver into Texas items it has sold, in company vehicles;

S. leasing: lease tangible personal property that is used in Texas.

Remarks:

I declare that the information in this document and any attachments is true and correct to the best of my knowledge and belief.

PROVIDING COMPLETE AND ACCURATE BUSINESS INFORMATION WILL EXPEDITE

THE PROCESSING OF YOUR QUESTIONNAIRE.

Please return the questionnaire to: Texas Comptroller of Public Accounts 111 E. 17th Street

Austin, TX 78774-0100

For assistance, call 1-800-252-1381 toll free nationwide or in Austin, call 512/463-4600. If you're calling from a Telecommunications Device for the Deaf

(TDD), the toll free number is 1-800-248-4099, or in Austin, 512/463-4621.