City of Kansas City, Missouri - Revenue Division
RD-100
REGISTRATION APPLICATION
(12/12)
Phone:
(816) 513-1135
Fax:
(816) 513-1264
E-file:
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
Non-profit (If not-for-profit, attach copy
1120s Corporation
Manufacturing
Service
of exemption certificate)
1065 Partnership
Construction
Hotel/Motel
# of rooms: ___________
Other, specify:
Governmental
Voluntary Withholding Only
(Non resident Employers)
_______________
Restaurant
Other, specify: ______________
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
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
DO NOT SEND CASH. Make check payable to:
KCMO City Treasurer
Mail to:
City of Kansas City, Missouri, Revenue Division, 1118 Oak St., Kansas City, MO 64106
For changes to name, address or FEIN/SSN, please contact us at or the phone number at the top of your return.
I authorize the Commissioner of Revenue or delegate to discuss my return and attachments with my preparer.
Yes
No
Under penalties of perjury, I declare this return to be a true, correct, and complete accounting for the taxable year stated.
Print Name of Taxpayer
Signature
Title
Date
Phone
Preparer Name (if other than taxpayer)
Signature
Title
Date
Phone