Form Rd-100 - Registration Application
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1REGISTRATION APPLICATION
RD-100
City of Kansas City MO
REV. 12/12
Finance Department Revenue Division
1118 Oak Street
Kansas City MO 64106-2786
(816) 513-1135 (Telephone)
(816) 513-1264 (Fax)
ADD NEW OR UPDATE EXISTING ACCOUNTS (check all that apply)
Business License Account
Convention & Tourism - Hotel Account
Utilities Account: Cable Company
Profits Account
Liquor Sales (Check if Applicable)
Utilities Account: Wireless Telephone Company
Withholding Account
Convention & Tourism - Food Account
Utilities Account: Telephone Company
Arena (Hotel/Motel)
Liquor Sales (Check if Applicable)
Utilities Account: Gas, Electric, or Steam Company
Arena (Car Rental)
Cigarette License Account
Domestic Employer
SOCIAL SECURITY / FEDERAL ID NUMBER
MISSOURI SALES TAX NUMBER
LEGAL NAME (INDIVIDUAL OR BUSINESS )
BUSINESS NAME (DBA)
MAILING ADDRESS
City
State
Zip code
LOCAL BUSINESS ADDRESS (IF ANY)
City
State
Zip code
BUSINESS TELEPHONE NUMBER
LOCAL BUSINESS TELEPHONE
FAX NUMBER
EMAIL ADDRESS
CONTACT NAME
General Information
Type Federal Return Filed
Type of Business
Classification of Business
1040 Individual
Retail Trade
Finance
Profit
1120 Corporation
Wholesale Trade
Real Estate
1120s Corporation
Manufacturing
Service
Non-profit (If not-for-profit, attach
1065 Partnership
Construction
Hotel/Motel
copy of exemption certificate)
Other, specify: __________________
Governmental
# of rooms: ____________
Restaurant Other, specify:_________
Voluntary Withholding Only
(Non resident Employers)
DATE OF INCORPORATION
STATE OF INCORPORATION
NUMBER OF EMPLOYEES LIVING OR WORKING IN
KCMO
KCMO START DATE
FISCAL YEAR END
NAICS CODE (IF KNOWN)
DESCRIBE (IN DETAIL) THE NATURE OF BUSINESS PERFORMED IN KCMO
LIST ALL OWNERS, PARTNERS OR OFFICERS (Attach additional names on separate sheet):
Name
Home Address and Telephone Number
Position
Social Security Number
Under penalties of perjury, I declare this return (and accompanying documentation) to be true, correct and complete. I authorize the Commissioner of Revenue or delegate
to discuss this tax return and accompanying documentation with my preparer__YES __NO
Signature of Taxpayer
Print Name
Date
Phone
City Resolution Number 070067 requests voluntary information regarding race, ethnicity, or gender in order to identify potential new businesses to participate in the City of
Kansas City, Missouri Minority-Owned Business Enterprise (MBE) and Woman-Owned Business Enterprise (WBE) Program.
Please check this box if you are a minority -owned or a woman-owned business
Visit our website at for more revenue forms and instructions
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Parent category: Legal