Form TC-51 Fillable Nexus Questionnaire
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

Employee and Contract Agent Information Nexus Questions (: 1) Unchecked (: 2) Unchecked (: 3) Unchecked (: 4) Unchecked (: 6) Unchecked (: No) Unchecked (: No) Unchecked (: No) Unchecked (: No) Unchecked (: No) Unchecked (: No) Unchecked (: No) Unchecked (: No) Unchecked (: No) Unchecked (: No) Unchecked (: No) Unchecked (: No) Unchecked (: No) Unchecked (: No) Unchecked (: No) Unchecked (: No) Unchecked (: No) Unchecked (: No) Unchecked (: No) Unchecked (: No) Unchecked (: No) Unchecked (: No) Unchecked (: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (a) Date first return filed: (b) Date last return filed: (c) Business name under which last return was filed: (checkbox) Unchecked (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) Remember to sign and date this form after printing it 1 Does the company have an office agency warehouse or other place of business in Utah? If YES list company name 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 14 Does the company have a standard form or written agreement with employees sales representatives commissioned 15 Are commissioned agents/independent contractors forbidden (by contractual agreement or otherwise) from selling or 16 List names and addresses of employees or representatives the territory they cover and designate whether they are employees or independent 17 Do any of the sales agents in Utah represent your corporation only? 18 List the company's three (3) major Utah customers: 19 Are there other types of activities in Utah? Please explain: 2 Does the company regularly solicit orders in Utah whether or not those orders are accepted in Utah? 210 N 1950 W SLC UT 84134 www tax utah gov 3 Does the company hold title to tangible personal or real property located in Utah i e merchandise inventory motor 4 Does the company rent or lease to others or has it at any time in the last three (3) years rented/leased property to 5 Does the company rent or lease from others or has it at any time leased or rented from others any tangible personal 6 Does the company have a Utah telephone number or use a Utah answering service? 7 Does the company have or has it at any time maintained or consigned stocks or goods in Utah (i e distribution 8 Does the company deliver to a Utah location by using company owned or leased vehicles? 9 Are contracts or similar agreements executed in Utah? agents or independent contractors? If YES enclose a sample copy Answer "Yes" or "No" to the following questions For answers that require additional information include that information on a separate sheet and Any kind of office other than an in home office Approving or accepting orders Carrying samples for sale exchange or distribution in any manner for consideration or other value City State Zip code Contact phone number Collecting delinquent accounts Company Information 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 Conducting training courses seminars or lectures Consigning tangible personal property to any person including an independent contractor contractors Use additional sheets if necessary Corporation Do you now or have you ever filed Utah Corporation Franchise/Income Tax Returns? If yes complete (a) (b) and (c) below Does the company have any employees sales representatives commission agents or independent contractors employees or other representatives began performance of these activities in Utah Entering into franchising or licensing agreements Exact business name Federal ID number Final consumers First date that business in Utah began or that Handling customer complaints Hiring training or supervising personnel other than personnel involved only in solicitation If no longer doing business within Utah income was derived from sources within Utah: indicate date business activity ceased: industrial equipment etc ? Installing or supervision of installation Investigating credit worthiness kind other than an in home office L L C location and nature of activities on a separate sheet Maintaining by either an in state or an out of state resident employee an office or place of business of any Maintaining sample or display room in excess of two weeks (14 days) during the year Making repairs or providing maintenance Meeting place for directors officers or employees Mobile stores i e trucks with driver salesmen Name of officer Name of preparer Nature of business and description of property and/or services sold Attach additional sheets if necessary Nexus Questionnaire Officer's mailing address Officer's phone number Other Information other than the facilitation or solicitation of orders Other: others who then use the property in Utah? If YES list lessee's name location and description of property on a Owning leasing maintaining or otherwise using any of the following facilities or property in state of Utah Partnership Parts department Picking up or replacing damaged or returned property Preparer's mailing address Preparer's phone number promoting your competitors' products? property located and/or used in Utah i e warehouse space motor vehicles office space housing space or Providing any kind of technical assistance or service when a purpose of that assistance or service is something Real property or fixtures of any kind reference the question number Repair shop Repossessing property Resellers residing selling soliciting or performing services in Utah? If YES list on a separate sheet the year(s) in which your Rev 9/02 Securing deposits on sales separate sheet Shipping or delivering goods into Utah by means of private vehicle rail air or other carrier Signature of officer Signature of preparer Signatures Sole Proprietor State Stock of goods Street address of principal office Contact person TC 51 Telephone answering service that carry out or that are responsible for any of the following activities in Utah? The following questions pertain to the type of activities performed by the employees or independent contract agent(s) within Utah Title of officer Type of business 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 Using agency stock checks or any other instrument by which sales are made within Utah by sales personnel Utah State Tax Commission vehicles office or industrial equipment etc ? If YES list owner location and description of such property on a Warehouse warehouse)? What was the company's total sales to customers in Utah and the total sales to all customers during the last three (3) years? Who are the company's customers? (check all that apply) Who are the company's customers? (check all that apply) Who are the company's customers? (check all that apply) Year Utah Sales Total Sales Zip code