COMMONWEALTH OF MASSACHUSETTS
DEPARTMENT OF REVENUE
Rulings & Regulations Bureau
100 Cambridge Street, P.O. Box 9566
Boston, MA  02114
 

QUESTIONNAIRE FOR CORPORATIONS

 

_________________________________________________________________________

Name and address of taxpayer


 

_________________________________________________________________________

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.
 

                   _________________________________________________________

                   _________________________________________________________

                   _________________________________________________________


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.
 

                   ___________________________________________________________

                   ___________________________________________________________

                   ___________________________________________________________


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.

                   ___________________________________________________________

                   ___________________________________________________________

                   ___________________________________________________________


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.  __________________________________________

                   ___________________________________________________________

                   ___________________________________________________________

                   ___________________________________________________________


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.
 

                   ___________________________________________________________

                   ___________________________________________________________

                   ___________________________________________________________


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.