Form 53-V - Vendor'S Use Tax Return - 2017

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Form
Missouri Department of Revenue
ADRE
53-V
for instructions to complete this form.
Vendor’s Use Tax Return
Select one if:
Missouri Tax Identification Number
Federal Employer Identification Number
r
r
Amended Return
Additional Return
Owner Name
Business Name
Reporting Period
Mailing Address
City
State
ZIP Code
Business Phone Number
Due Date
E-mail Address
-
(
)
___ ___ / ___ ___ / ___ ___ ___ ___
___ ___ ___
___ ___ ___
___ ___ ___ ___
Department
r
Address Correction:
Mailing Address
Use Only
This return must be filed for the reporting period indicated even if you have no taxable purchases to report.
Adjustments
Taxable
Business Location
Gross Receipts
Code
Rate (%)
Amount of Tax
(Indicate + or -)
Sales
-
-
-
-
-
-
-
-
-
-
-
-
Page 1 Totals ......................................................
-
Page
--
Totals .....................................
-
1.
Totals (All Pages) ................................................
Subtract: 2% timely payment
2.
Check our website at
for the correct tax
-
allowance (if applicable) ..................
rate. If the rate is more than 4.225%, local tax applies and you must add that higher
3.
rate to your return.
Total vendor’s use tax due ..............
=
Add: interest for late
4.
Final Return: If this is your final return, enter the close date below and check the
+
payment (See Line 4 of Instructions)
reason for closing your account. Missouri law requires any person selling or
5.
discontinuing business to make a final use tax return within fifteen (15) days of the
+
Add: additions to tax ........................
sale or closing.
6.
Subtract: approved credit ................
-
___ ___ / ___ ___ / ___ ___ ___ ___
Date Business Closed:
Pay this amount
7.
r
r
r
(U.S. Funds Only) ......................
=
Out of Business
Sold Business
Leased Business
Department Use Only
If you pay by check, you authorize the Department of Revenue to process the check
electronically. Any check returned unpaid may be presented again electronically.
Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct. I have direct control,
supervision, or responsibility for filing this return and payment of the tax due. I attest that I have no gross receipts to report for locations left blank.
Taxpayer or Authorized Agent’s Signature
Title
Date (MM/DD/YYYY)
__ __ /__ __ /__ __ __ __
Printed Name
Tax Period (MM/DD/YYYY) though (MM/DD/YYYY)
__ __ /__ __ /__ __ __ __
through
__ __ /__ __ /__ __ __ __
Form 53-V (Revised 01-2017)
Mail to:
Taxation Division
Phone: (573) 751-2836
Visit
P.O. Box 840
TTY: (800) 735-2966
for additional information.
Jefferson City, MO 65105-0840
Fax: (573) 751-7273
E-mail:
salesuse@dor.mo.gov

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