Form 2039 - Nonprotested Sales Tax Payment Report
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DOR USE ONLY
MISSOURI DEPARTMENT OF REVENUE
FORM
TAXATION BUREAU
2039
P.O. BOX 3350, JEFFERSON CITY, MISSOURI 65105-3350
(573) 526-9938
FAX (573) 751-9409
TDD (800) 735-2966
(REV. 11-2007)
NONPROTESTED SALES TAX PAYMENT REPORT
MITS NUMBER
REPORTING PERIOD
___ ___ ___ ___ ___ ___ ___ ___
OWNER’S NAME
BUSINESS NAME
MAILING ADDRESS
PHONE NUMBER
(___ ___ ___) ___ ___ ___ - ___ ___ ___ ___
CITY
STATE
ZIP CODE
___ ___ ___ ___ ___
NPRE
(DO NOT WRITE IN SHADED AREAS)
This form is to be used in conjunction with the Sales Tax Protest Affidavit (DOR-163). Any nonprotested sales tax payments in a reporting period for which you filed a Protest
Payment Affidavit must be reported on this form. Return completed form to: Taxation Bureau, P.O. Box 3350, Jefferson City, MO 65105-3350.
ADJUSTMENTS
TAX
BUSINESS LOCATION
TAX TYPE
GROSS RECEIPTS
TAXABLE SALES
AMOUNT OF TAX
RATE (%)
(INDICATE + OR – )
STATE
3%
CONSERVATION
1/8%
EDUCATION
1%
PARKS/SOIL
1/10%
Reset This Section Only
ENTER TOTAL AMOUNT OF TAX FROM SCHEDULE A (Page 3)
1.
ENTER TOTAL AMOUNT OF TAX
2.
FINAL RETURN: If this is your final return, enter the close date below and check the reason for closing
SUBTRACT: 2% of Line 1
ONLY if paid by due date
your account. The Sales Tax law requires any person selling or discontinuing business to make a final
–
sales tax return within fifteen (15) days of the sale or closing.
3.
TOTAL AMOUNT OF TAX DUE:
(Line 1 minus Line 2)
=
Date Business Closed:
4.
ADD: Interest for late payment
Out of Business
Sold Business
Leased Business
(See Instructions)
+
5.
ADD: Additions to Tax (5% per month
SIGN AND DATE RETURN: This must be signed and dated by the taxpayer or by the taxpayer’s autho-
late of Line 3, maximum 25%)
+
rized agent. Mail to: Missouri Department of Revenue, P.O. Box 3350, Jefferson City, MO 65105-3350.
6.
REMIT SINGLE CHECK FOR THIS
AMOUNT: (Add Lines 3, 4, 5)
=
If you pay by check, you authorize the Department of Revenue to process the check electronically. Any
check returned unpaid may be presented again electronically.
TAX PERIOD
I have direct control, supervision or responsibility for filing this report and payment of the tax due.
MONTH
DAY
YEAR
MONTH
DAY
YEAR
Under penalties of perjury, I declare that this is a true, accurate and complete report. REPORT
MUST BE SIGNED AND DATED.
__ __ /__ __ / __ __ __ __
__ __ /__ __ / __ __ __ __
THRU
SIGNATURE OF TAXPAYER OR AGENT
TITLE
DATE
___ ___ / ___ ___ / ___ ___ ___ ___
This publication is available upon request in alternative accessible format(s).
MO 860-1521 (11-2007)
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