Form 4760 - Supplier Notification Of Uncollectible Tax Page 2
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2SUPPLIER NOTIFICATION OF UNCOLLECTIBLE TAX
Instructions
This form is to be completed when notifying the director of failure to collect tax from an eligible purchaser.
Fuel Codes
065 — Gasoline
142 — Kerosene
284 — Bio-Diesel – Undyed B100
123 — Alcohol
130 — Jet Fuel
285 — Soy Oil
241 — Ethanol
072 — Dyed Kerosene
290 — Bio-Diesel – Dyed B100
124 — Gasohol
160 — Diesel Fuel
122 — Blending Components
125 — Aviation Gasoline
228 — Dyed Diesel Fuel
(Identify) ______________________
General Instructions
Supplier name, address, license number and FEIN —
Enter the name, numbers and address information for the supplier.
Eligible Purchaser name, address, license number, and FEIN — Enter the name, numbers and address information of the defaulting eligible
purchaser.
Transaction Information —
Enter the requested information identifying the transactions on which tax
was not remitted by the eligible purchaser.
Sign and date the form.
Notification of uncollectible tax must be submitted within ten (10) business days following the earliest date on which the supplier was entitled
to collect the tax from the eligible purchase. Failure to provide notification within the specified period will result in credit being disallowed.
The credit is to be claimed by completing an Affidavit For Bad Debt Loss (Form 8A) and returning it with the first return following the expiration
of the ten-day period.
Credit is limited to the amount of tax and fees due from the purchaser, including any accruals within the ten (10) day notification period.
If you have questions or need assistance in completing this form, please call (573) 751-2611 or e-mail excise@dor.mo.gov. You may also
access the department’s web site at to obtain this form.
MO 860-2839 (11-2006)
DOR-4760 (11-2006)
SUPPLIER NOTIFICATION OF UNCOLLECTIBLE TAX
Instructions
This form is to be completed when notifying the director of failure to collect tax from an eligible purchaser.
Fuel Codes
065 — Gasoline
142 — Kerosene
284 — Bio-Diesel – Undyed B100
123 — Alcohol
130 — Jet Fuel
285 — Soy Oil
241 — Ethanol
072 — Dyed Kerosene
290 — Bio-Diesel – Dyed B100
124 — Gasohol
160 — Diesel Fuel
122 — Blending Components
125 — Aviation Gasoline
228 — Dyed Diesel Fuel
(Identify) ______________________
General Instructions
Supplier name, address, license number and FEIN —
Enter the name, numbers and address information for the supplier.
Eligible Purchaser name, address, license number, and FEIN — Enter the name, numbers and address information of the defaulting eligible
purchaser.
Transaction Information —
Enter the requested information identifying the transactions on which tax
was not remitted by the eligible purchaser.
Sign and date the form.
Notification of uncollectible tax must be submitted within ten (10) business days following the earliest date on which the supplier was entitled
to collect the tax from the eligible purchase. Failure to provide notification within the specified period will result in credit being disallowed.
The credit is to be claimed by completing an Affidavit For Bad Debt Loss (Form 8A) and returning it with the first return following the expiration
of the ten-day period.
Credit is limited to the amount of tax and fees due from the purchaser, including any accruals within the ten (10) day notification period.
If you have questions or need assistance in completing this form, please call (573) 751-2611 or e-mail excise@dor.mo.gov. You may also
access the department’s web site at to obtain this form.
MO 860-2839 (11-2006)
DOR-4760 (11-2006)
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