Notice Of Business Activity Report

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Address (Number and Street or Rural Route) State of Incorporation City, Town or Post Office and State Zip Code Date of Incorporation Principal Type of Business Location of Principal Office Offices and Other Places of Business in New Jersey: Location Nature of Activity Officers, Employees, Agents and Representatives in New Jersey (attach fully descriptive duty statement for each officer and each class of employee, agent or representative) Title Number of Persons GENERAL INFORMATION 1.. SUBMIT COMPLETED FORM TO: NJ DIVISION OF TAXATION OFFICE AUDIT BRANCH 50 BARRACK STREET PO BOX 269 TRENTON, NJ 08695‐0269 Signature of Officer CBA-1 (03-10, R-4, ct) Title Date Pg 2 CORPORATION BUSINESS ACTIVITIES REPORTING ACT INSTRUCTIONS (by Question) (1) Includes the maintenance of an office or other place of business maintenance of personnel, including the presence of employees, agents, representatives or independent contractors in connection with the corporation s business, even though not regularly stationed in New Jersey..

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