Form 53-C - Consumer'S Use (573) 751-2836 Tax Return - State Of Missouri

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MISSOURI DEPARTMENT OF REVENUE
MISSOURI TAX I.D. NUMBER
FEDERAL I.D. NUMBER
TAXATION DIVISION
P.O. BOX 840
FORM
JEFFERSON CITY, MO 65105-0840
__ __ __ __ __ __ __ __
__ __ __ __ __ __ __ __ __
53-C
CONSUMER’S USE
(573) 751-2836
• DO NOT WRITE IN SHADED AREAS
TAX RETURN
TDD (800) 735-2966
(REV. 01-2011)
Check box if Amended Return
Or Additional Return
OWNER’S NAME
REPORTING PERIOD
ADDRESS CORRECTION
BUSINESS NAME
MAILING ADDRESS
REPORTING LOCATION
BUSINESS PHONE NUMBER:
MAILING ADDRESS
PHONE NUMBER
(__ __ __) __ __ __ - __ __ __ __
(__ __ __) __ __ __ - __ __ __ __
CITY
STATE
ZIP
DUE DATE:
__ __ __ __ __
IMPORTANT: THIS RETURN MUST BE FILED FOR THE REPORTING PERIOD INDICATED EVEN IF YOU HAVE NO TAXABLE PURCHASES TO REPORT.
I do not have cumulative taxable purchases totaling more than $2,000 this calendar year and do not owe Consumer’s Use Tax at this time.
BUSINESS LOCATION
CODE
TAXABLE PURCHASES
RATE (%)
AMOUNT OF TAX
PAGE 1 TOTALS . . . . . . . . . . . . . . . . . . . . . . . . . . .
PAGE
--
TOTALS
. . . . . . . . . . . . . . . . . .
1.
TOTALS (ALL PAGES) . . . . . . . . . . . . . . . . . . . . . .
Instructions are updated annually and are provided on our web site at
2.
ADD: INTEREST FOR LATE
+
PAYMENT (See Line 2 of Instructions) . .
FINAL RETURN: If this is your final return, enter the close date below and check the reason for closing your account.
Missouri law requires any person selling or discontinuing business to make a final use tax return within fifteen
3.
(15) days of the sale or closing.
ADD: ADDITIONS TO TAX . . . . . . . . . . .
+
Date Business Closed: ___________________________
Out of Business
Sold Business
Leased Business
4.
-
SIGN AND DATE RETURN: This must be signed and dated by the taxpayer or by the taxpayer’s authorized agent.
SUBTRACT: APPROVED CREDIT . . . . .
Mail to: Missouri Department of Revenue, P.O. Box 840, Jefferson City, MO 65105-0840.
PAY THIS AMOUNT
I have direct control, supervision, or responsibility for filing this return and payment of the tax due. Under penalties of
5.
(U.S.Funds only) . . . . . . . . . . . . . . . .
perjury, I declare that this is a true, accurate, and complete return. I also declare under penalties of perjury that I
employ no illegal or unauthorized aliens as defined under federal law and that I am not eligible for any tax exemption,
credit or abatement if I employ such aliens.
I ATTEST THAT I HAVE NO TAXABLE PURCHASES TO REPORT FOR LOCATIONS LEFT BLANK.
DOR USE ONLY
SIGNATURE OF TAXPAYER OR AGENT
TITLE
DATE SIGNED
TAX PERIOD (MMDDYYYY) THROUGH (MMDDYYYY)
__ __ - __ __ - __ __ __ __
__ __ - __ __ - __ __ __ __
through
_ _ / _ _ / _ _ _ _
FORM 53-C (01-2011)
Visit to determine if you have a credit for which you may be entitled to a refund.

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