Form Rd-100 - Registration Application - State Of Missouri

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