Free TC-51.ai - Utah

Utah State Tax Commission
210 N 1950 W · SLC, UT 84134 · www.tax.utah.gov

TC-51
Rev. 9/02

Nexus Questionnaire
Company Information
Exact business name Street address of principal office City Type of business State Zip code Federal ID number Contact person Contact phone number

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 Yes No

Final consumers

Do you now or have you ever filed Utah Corporation Franchise/Income Tax Returns? If yes, complete (a), (b) and (c) below.

(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. 2. 3. Does the company have an office, agency, warehouse or other place of business in Utah? If YES, list company name, ............... location and nature of activities on a separate sheet. Does the company regularly solicit orders in Utah, whether or not those orders are accepted in Utah? ......................................... Does the company hold title to tangible personal or real property located in Utah, i.e., merchandise inventory, motor .................. vehicles, office or industrial equipment, etc.? If YES, list owner, location and description of such property on a separate sheet. Does the company rent or lease to others or has it at any time in the last three (3) years rented/leased property to ..................... others who then use the property in Utah? If YES, list lessee's name, location and description of property on a separate sheet. Does the company rent or lease from others or has it at any time leased or rented from others any tangible personal ................. property located and/or used in Utah, i.e., warehouse space, motor vehicles, office space, housing space or industrial equipment, etc.? Does the company have a Utah telephone number or use a Utah answering service? ................................................................... Does the company have or has it at any time maintained or consigned stocks or goods in Utah (i.e. distribution .......................... warehouse)? Does the company deliver to a Utah location by using company owned or leased vehicles? .......................................................... Are contracts or similar agreements executed in Utah? ...................................................................................................................

Yes Yes Yes

No No No

4.

Yes

No

5.

Yes

No

6. 7. 8. 9.

Yes Yes Yes Yes

No No No No

10. Does the company engage in any activity in connection with the leasing or servicing of property located in Utah? ....................... 11. Does the company have or has it ever had a security interest in any real or personal property sold or located in Utah? ............... 12. Does the company have any employees, commissioned agents, independent contractors or other representatives ..................... 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.

Yes Yes Yes

No No No

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. b. c. d. e. f. g. h. i. j. k. l. m. n. o. p. q. Making repairs or providing maintenance ................................................................................................................................ Collecting delinquent accounts ................................................................................................................................................ Investigating credit worthiness ................................................................................................................................................. Installing or supervision of installation ..................................................................................................................................... Conducting training courses, seminars or lectures .................................................................................................................. Providing any kind of technical assistance or service when a purpose of that assistance or service is something ................ other than the facilitation or solicitation of orders Handling customer complaints ................................................................................................................................................ Approving or accepting orders ................................................................................................................................................ Repossessing property ............................................................................................................................................................ Securing deposits on sales ...................................................................................................................................................... Picking up or replacing damaged or returned property ............................................................................................................ Hiring, training or supervising personnel, other than personnel involved only in solicitation ................................................... Using agency stock checks or any other instrument by which sales are made within Utah by sales personnel ..................... Maintaining sample or display room in excess of two weeks (14 days) during the year .......................................................... Carrying samples for sale, exchange or distribution in any manner for consideration or other value ..................................... Consigning tangible personal property to any person, including an independent contractor .................................................. Owning, leasing, maintaining or otherwise using any of the following facilities or property in state of Utah 1. 2. 3. 4. 5. 6. 7. 8. 9. r. s. t. Repair shop ..................................................................................................................................................................... Parts department ............................................................................................................................................................. Any kind of office other than an in-home office ................................................................................................................ Warehouse ...................................................................................................................................................................... Meeting place for directors, officers or employees .......................................................................................................... Stock of goods ................................................................................................................................................................. Telephone answering service .......................................................................................................................................... Mobile stores, i.e., trucks with driver salesmen ............................................................................................................... Real property or fixtures of any kind ................................................................................................................................

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

No No No No No No No No No No No No No No No No

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

No No No No No No No No No No No No No No

Maintaining, by either an in-state or an out-of-state resident employee, an office or place of business of any ....................... kind other than an in-home office Entering into franchising or licensing agreements ................................................................................................................... Shipping or delivering goods into Utah by means of private vehicle, rail, air or other carrier ..................................................

14. Does the company have a standard form or written agreement with employees, sales representatives, commissioned ................ 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 ................ 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
18. List the company's three (3) major Utah customers:

19. Are there other types of activities in Utah? Please explain:

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 Signature of officer Title of officer Date

Remember to sign and date this form after printing it.
Officer's mailing address City Name of preparer Signature of preparer Date State Zip code Officer's phone number

Remember to sign and date this form after printing it.
Preparer's mailing address City State Zip code Preparer's phone number