Free Bank Nexus Questionnaire - Texas

AP-223 (12-07)

STATE OF TEXAS

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CLEAR FIELDS

BANK NEXUS QUESTIONNAIRE
for Savings and Loans, State Banks, Federal Banks, Savings Banks and Foreign Country Banks
ACID

Texas taxpayer number File number
You have certain rights under Chapters 552 and 559,

Government Code, to review, request and correct information we have on file about you. Contact us at the address or toll-free number listed on this form.

1. Entity name 3. Mailing address (if different than above address)
City State

2. Federal employer identification number (FEIN)

ZIP code

4. Contact person

5. Contact phone (Area code and number)

6. Bank entity type State bank (FO) State savings bank (FH) State savings and loan (FA) 7. In what state or country was this entity formed? Formation date Federal bank (FJ) Federal savings bank (FK) Federal savings and loan (FN) Foreign country bank (FR)
month day year

8. If this entity is registered with the Texas Secretary of State, please provide the file number. 9. Please provide the entity's North American Industry Classification System (NAICS) code.
(NAICS codes are available at www.census.gov/epcd/www/naics.html.)

10. Please list any tax permits or licenses issued to this entity by the Texas Comptroller.
Type of permit or license

Taxpayer number for permit or license

If included in a combined group Texas Franchise Tax Report, provide the reporting entity's Texas taxpayer number 11. Please describe this entity's business activities: 12. Please check the items pertaining to this entity in Texas during the last seven years. Place of business
(maintaining a place of business, manufacturing plant, office, warehouse or retail outlet, owned or leased) (with own employees, local labor or contractors) (items sold and delivered into Texas in company vehicles) (with own employees or third party) (hold, acquire, lease or dispose of) (hold, acquire, lease, install, erect, modify, maintain, repair or dispose of personal property used or located in Texas) (in a general or limited partnership that is doing business in Texas) (staging of or participation in shows, theatrical performances, sporting events or other events in Texas)

START DATE
month day year

Performance of a contract Delivering

Warranty work

Real property in Texas Personal property General partner Shows

(continued on back)

Form AP-223 (Back)(12-07)

12. Please check the items pertaining to this entity in Texas during the last seven years. (continued) Inventory
(including consigned goods) (solicit sales/loan contracts, gather data, make credit checks or other financial activities in Texas with own employees, independent contractors or agents) (promote sales/service using employees, independent contractors, agents or other representatives) (including temporary employees, contractors, agents)

START DATE
month day year

Loan production activities Solicitation

Employees/independent representatives Processing, manufacturing, storing goods Sell and license software in Texas Processing and shipment Advertising

(send materials to Texas manufacturer, processor, repairer or printer to be processed, stored in completed form, awaiting orders for shipment) (enter Texas to purchase, place or display advertising for the benefit of another) (through employees, independent contractors, agents or other representatives) (doing business in Texas even if the area is leased, owned or controlled by the federal government) (maintain place of business, manage, direct and/or perform services for subsidiaries or related entities) (carry passengers or property where the pickup and delivery is in Texas; have Texas facilities, employees or other representatives for storage, delivery, shipping of goods; servicing, maintaining, repairing vehicles or other equipment; coordinating/directing the transportation of passengers or property) (contracts where a franchisee is granted the right to engage in business under a marketing plan/system substantially prescribed by the franchisor or if franchisee's business is substantially associated with the franchisor's brand, service mark or other commercial symbol)

Provide a service Federal enclave

Holding company Transportation

Franchisors

13. Please provide a full description of the entity's activities in Texas. If the entity no longer has nexus in Texas, enter the end date of the entity's activities in Texas and provide the reason why this entity does not have Texas franchise tax responsibility.
_______________________________________________________________________________________________

_______________________________________________________________________________________________

Nexus end date
month day year

_______________________________________________________________________________________________

I declare that the information in this document and any attachment is true and correct to the best of my knowledge and belief.
Print preparer's name Title Date Phone (Area code and number)

Please return this completed questionnaire to: Texas Comptroller of Public Accounts P.O. Box 149348 Austin, TX 78714-9348 FOR ASSISTANCE: Information about franchise tax is available online at www.window.state.tx.us/taxinfo/franchise/. For taxpayer assistance, call (800) 252-1381, toll free nationwide. The local number in Austin is (512) 463-4600. Our e-mail address is [email protected].