NEXUS-IMMUNE ACTIVITY DECLARATION
For Periods Beginning On or After January 1, 2002
For taxable year beginning ______________________, _________ and ending ______________________, _________
Read the instructions on the reverse side before completing this schedule
Did this corporation, during the period covered by this return, perform any of the following activities in New Jersey:
1. Own, lease or rent any real property in New Jersey?
2. Lease tangible property to others for use in New Jersey?
3. Own or lease vehicles registered in New Jersey which are provided to people who are not sales people?
4. Own, lease or rent any type of property located in New Jersey (consignments, inventory, drop shipments, or like transactions)?
5. License the use of any intangible rights from which royalties, licensing fees, etc., are derived from the use of these rights in
New Jersey (for example without limitations, software licenses, trademarks)?
6. Solicit in New Jersey for services through the use of employees, officers, agents and/or independent contractors or
7. Perform any type of service in New Jersey (other than solicitation) such as constructing, erecting, installing, repairing,
consulting, training, conducting seminars or meetings or administering credit investigations through the use of employees,
agents, sub- contractors and/or independent contractors or representatives?
8. Provide any technical assistance or expertise which is performed in New Jersey through the use of employees, agents, sub-
contractors and/or independent contractors or representatives?
9. Perform any detail work in New Jersey without limitations such as taking inventory, stocking shelves, maintaining displays,
arranging delivery through the use of employees, agents, sub-contractors and/or independent contractors or representatives?
10. Carry goods, merchandise, inventory, or other property including samples into New Jersey for direct sale to customers in New
11. Pick-up and/or replace damaged, returned or repossessed goods from New Jersey customers with company owned vehicles or
through contract carriers?
12. Does this company make pick-up or deliveries to points in New Jersey with company owned vehicles or through contract
carriers for any other company other than itself ?
13. Provide any type of maintenance program which is performed in New Jersey by either this entity or an independent contractor?
14. Have sales representatives who have the authority to accept or approve sales orders from customers located in New Jersey in
which acceptance/approval takes place in New Jersey and not from an out-of-state location?
15. Have employees, independent contractors or representatives with in-home offices in New Jersey for which they are reimbursed
for expenses other than telephone or travel or have employees working from home telecommuting on a regular basis for the
convenience of the taxpayer?
16. Own an interest in either a partnership or LLC doing business in New Jersey? If yes, identify the name and address of the
partnership or LLC.
17. Secure deposits for sales or payment for sales and/or deliveries?
Allow catalog or on-line sales to be returned or picked up at an in-store location of a related or affiliated company?
19. Collect delinquent accounts directly or indirectly or repossess property?
20. Maintain a display at a single location for more than two weeks?
AFFIRMATION OF INFORMATION BY AN OFFICER/RESPONSIBLE INDIVIDUAL
I hereby certify that this schedule, including any accompanying riders, is to the best of my knowledge a true, correct and complete report.
Name: _________________________________________________ Title: ________________________________________________
Signature: ________________________________________________ Date: ________________________________________________
Corporation Name Federal ID Number