Form Mo-96 - Annual Summary And Transmittal Of Missouri

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MISSOURI DEPARTMENT OF REVENUE
FORM
200
TAXATION BUREAU
MO-96
P O BOX 2200, JEFFERSON CITY, MO 65105-2200
ANNUAL SUMMARY AND TRANSMITTAL OF MISSOURI FORMS MO-99 MISC.
(REV. 10-2006)
NOTE: Enter the total number of Federal 1099 NEC forms if substituted for the Missouri Form MO-99 MISC.
All documents are: (Place an “X” in the proper boxes.)
ENTER
NUMBER OF
WITH TAXPAYER
WITHOUT TAXPAYER
ORIGINAL
CORRECTED
DOCUMENTS
IDENTIFYING NO.
IDENTIFYING NO.
PAYER’S identifying number
Mail to: Missouri Department of Revenue
P.O. Box 2200
Jefferson City, Missouri 65105-2200
I have direct control, supervision or responsibility for filing this return and payment of the tax due. Under
penalties of perjury, I declare it is a true, accurate and complete return. In the case of documents without
recipients’ identifying numbers I have complied with the requirements of the law by requesting such
Type or Print PAYER’S name, address, and ZIP code above.
numbers from the recipients, but did not receive them.
SIGNATURE
TITLE
DATE
This publication is available upon request in alternative accessible format(s).
MO 860-1106 (10-2006)
MISSOURI DEPARTMENT OF REVENUE
FORM
200
TAXATION BUREAU
MO-96
P O BOX 2200, JEFFERSON CITY, MO 65105-2200
ANNUAL SUMMARY AND TRANSMITTAL OF MISSOURI FORMS MO-99 MISC.
(REV. 10-2006)
NOTE: Enter the total number of Federal 1099 NEC forms if substituted for the Missouri Form MO-99 MISC.
All documents are: (Place an “X” in the proper boxes.)
ENTER
NUMBER OF
WITH TAXPAYER
WITHOUT TAXPAYER
ORIGINAL
CORRECTED
DOCUMENTS
IDENTIFYING NO.
IDENTIFYING NO.
PAYER’S identifying number
Mail to: Missouri Department of Revenue
P.O. Box 2200
Jefferson City, Missouri 65105-2200
I have direct control, supervision or responsibility for filing this return and payment of the tax due. Under
penalties of perjury, I declare it is a true, accurate and complete return. In the case of documents without
recipients’ identifying numbers I have complied with the requirements of the law by requesting such
Type or Print PAYER’S name, address, and ZIP code above.
numbers from the recipients, but did not receive them.
SIGNATURE
TITLE
DATE
This publication is available upon request in alternative accessible format(s).
MO 860-1106 (10-2006)
MISSOURI DEPARTMENT OF REVENUE
FORM
200
TAXATION BUREAU
MO-96
P O BOX 2200, JEFFERSON CITY, MO 65105-2200
ANNUAL SUMMARY AND TRANSMITTAL OF MISSOURI FORMS MO-99 MISC.
(REV. 10-2006)
NOTE: Enter the total number of Federal 1099 NEC forms if substituted for the Missouri Form MO-99 MISC.
All documents are: (Place an “X” in the proper boxes.)
ENTER
NUMBER OF
WITH TAXPAYER
WITHOUT TAXPAYER
ORIGINAL
CORRECTED
DOCUMENTS
IDENTIFYING NO.
IDENTIFYING NO.
PAYER’S identifying number
Mail to: Missouri Department of Revenue
P.O. Box 2200
Jefferson City, Missouri 65105-2200
I have direct control, supervision or responsibility for filing this return and payment of the tax due. Under
penalties of perjury, I declare it is a true, accurate and complete return. In the case of documents without
recipients’ identifying numbers I have complied with the requirements of the law by requesting such
Type or Print PAYER’S name, address, and ZIP code above.
numbers from the recipients, but did not receive them.
SIGNATURE
TITLE
DATE
This publication is available upon request in alternative accessible format(s).
MO 860-1106 (10-2006)

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