COMMONWEALTH OF MASSACHUSETTS
DEPARTMENT OF REVENUE
Rulings & Regulations Bureau
100 Cambridge Street, P.O. Box 9566
Boston, MA 02114
QUESTIONNAIRE FOR CORPORATIONS
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Name and address of taxpayer
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1. Legal name of the corporation ____________________________________________
2. Address of principal office _______________________________________________
3. State of incorporation ___________________________________________________
4. Date of incorporation ___________________________________________________
5. Federal Identification Number ____________________________________________
6. Has your corporation qualified to do business in Massachusetts?
Yes No
7. Has your corporation, at any time, made sales into Massachusetts?
Yes No
8. Does your corporation have resident employees in Massachusetts?
Yes No
If yes, how many? _____________________
9. Does your corporation withhold income taxes from in‑state residents?
Yes No
10. Has your corporation, at any time, had an office, agency, warehouse, sample or display room, or any other place of business in the State of Massachusetts?
Yes No
If yes, please specify the location, dates, and nature of activities.
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_________________________________________________________
_________________________________________________________
11. Has your corporation, at any time, owned any tangible personal or real property located and/or used in Massachusetts (i.e., inventory, consigned inventory, motor vehicles, equipment...)?
Yes No
If yes, please specify type of property, location, and applicable years.
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___________________________________________________________
___________________________________________________________
12. Has your corporation, at any time, leased or rented any tangible personal or real property located and/or used in Massachusetts (i.e., warehouse space, motor vehicles, office space...)?
Yes No
If yes, please specify type of property, location, and applicable years.
___________________________________________________________
___________________________________________________________
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13. Have employees of your corporation (or representatives), at any time, collected delinquent accounts from Massachusetts customers?
Yes No
14. Have employees of your corporation, at any time, conducted business in Massachusetts through independent representatives (i.e., salesmen, agents, brokers...)?
Yes No
15. Do these representatives maintain an office of any kind in Massachusetts (e.g., home offices, sample or display room)?
Yes No
If yes, please specify type of office, location and applicable time periods.
___________________________________________________________
___________________________________________________________
16. Do these independent representatives conduct business for any other unaffiliated companies?
Yes No
17. Have employees of your corporation (or independent representatives), at any time, approved customer orders in Massachusetts?
Yes No
18. Have employees of your corporation (or independent representatives), at any time, investigated creditworthiness of Massachusetts customers?
Yes No
If yes, describe how. __________________________________________
___________________________________________________________
___________________________________________________________
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19. Have employees of your corporation (or independent representatives) at any time, provided any type of service in Massachusetts (i.e., repair, engineering, maintenance, installation...)?
Yes No
If yes, please specify type of service and applicable years.
___________________________________________________________
___________________________________________________________
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20. Have employees of your corporation (or independent representatives), at any time, inspected your corporation's products or offered technical assistance as to the use of such products in Massachusetts after installation in this state?
Yes No
21. Have employees of your corporation (or independent representatives), at any time, made deliveries of products into Massachusetts by means of vehicles owned or leased by your corporation?
Yes No
22. Have your employees (or independent representatives), at any time, picked up or verified destroyed, damaged, or returned merchandise in Massachusetts?
Yes No
23. Have any of your employees (or independent representatives), at any time, distributed samples in Massachusetts?
Yes No
If yes, please state the quantity and value of the samples, applicable years, and what is done with the samples.
___________________________________________________________
___________________________________________________________
24. Does your corporation receive any consideration for these samples?
Yes No
If yes, please explain. ________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
25. Have employees of your corporation (or independent representatives), at any time, conducted lectures or training courses in Massachusetts for customers, agents, or distributors with respect to your products?
Yes No
If yes, please describe. _________________________________________
_____________________________________________________________
26. Does your corporation retain a security interest in any goods you sell to Massachusetts customers?
Yes No
If yes, please state the number of repossessions per year.
________
Who conducts these repossessions? _____________________________
___________________________________________________________
___________________________________________________________
27. Has your corporation, at any time, engaged in any activities in Massachusetts not previously mentioned above?
Yes No
If yes, please specify. _______________________________________________
_________________________________________________________________
28. Has your corporation ever filed returns with the Massachusetts Department of Revenue?
Yes No
If yes, please specify:
Date Last
Date Last
Yes No Return Filed ID# Used
Corporate Excise:
Sales/Use Tax:
Meals Tax:
Room Occupancy:
Withholding Tax:
Name of Preparer (print or type) ________________________________________
Title: ________________________________________
Date: ________________________________________
Signature of Preparer: ________________________________________
Signed under the pains and penalties of perjury.