Fillable Form 943t - Request For Tax Clearance For Transient Employers printable pdf download

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Department Use Only

Missouri Department of Revenue

Form

(MM/DD/YY)

Request for Tax Clearance for Transient Employers

943T

Missouri Tax I.D.

Federal Employer

Number

I.D. Number

Charter

Reporting Period

Number

(MM/YY)

Home State of Incorporation

Begin Date Doing Missouri Business or

Certificate of Authority in Missouri

___ ___

___ ___ ___ ___

1. Does this business have Missouri resident employees for which they are required to withhold Missouri taxes?

Yes

2. Does the business have non-resident employees working in Missouri?

Yes

3. Do you pay contributions to the Division of Employment Security?

Yes

If yes, what is the account number? _______________

Note: If there has been a change in the ownership of your business, contact the Taxation Division at the telephone number below to

ensure your account is properly registered prior to requesting a Tax Clearance.

Corporation

Partnership

Sole Proprietorship

Limited Liability Company — Taxed as (select one)

Corporation

Sole Owner

Partnership

Name of Business or Corporation

Doing Business As (DBA)

Business Mailing Address

City

State

Zip Code

Contact Person Phone Number

Contact Person E-mail Address

(

)

___ ___ ___

___ ___ ___ ___

If there has been a name change for this corporation, please provide the prior name. ______________________________________

This corporation files consolidated corporation income tax returns in Missouri.

a. Parent corporation’s FEIN that returns are filed under

b. Missouri Tax Identification Number of the parent corporation

Federal Tax Identification Number (FEIN)

Missouri Tax Identification Number

Missouri corporation franchise tax returns cannot be filed consolidated and must be filed by each corporation.

Your Social Security Number

Spouse’s Social Security Number

If individual income tax returns have previously been filed in another state, please provide a list of the states and years filed.

___________________________________________________________________________________________________

Authorization for Release of Confidential Information: All correspondence will be released to the person authorized below. Release of

this information to a third party (such as an accountant) at the request of the taxpayer does not give the third party authority to request

further information from the Department. To obtain additional information or to represent the taxpayer before the Department, the

taxpayer must execute a Power of Attorney designating the third party as its representative.

Name of Person Authorized to Receive This Information

Title

Phone Number

(

)

___ ___ ___

___ ___ ___ ___

Address

City

State

Zip Code

Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct.

Signature of Owner or Officer

Printed Name

Title

Telephone Number

Date (MM/DD/YYYY)

(

)

___ ___

___ ___ ___ ___

___ ___ ___

___ ___ ___ ___

Form 943T (Revised 09-2014)

Mail to: Taxation Division

Phone: (573) 751-0459

P.O. Box 357

Fax: (573) 522-1722

*14604010001*

Jefferson City, MO 65105-0357

E-mail:

businesstaxregister@dor.mo.gov

Visit

for additional information.

14604010001

Form 943t - Request For Tax Clearance For Transient Employers

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