Form 943t - Request For Tax Clearance For Transient Employers

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MISSOURI DEPARTMENT OF REVENUE
FORM
REQUEST FOR TAX CLEARANCE FOR
Reset Form
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943T
TRANSIENT EMPLOYERS
Phone: (573) 751-0459
Fax: (573) 522-1721
(REV. 11-2007)
This form must be filed before any information can be disclosed. Please complete this form in its entirety and mail to the Missouri Depart-
ment of Revenue, Taxation Bureau, P.O. Box 295, Jefferson City, Missouri 65105-0295. This will ensure that your clearance is
processed without unnecessary delay.
TYPE OF OWNERSHIP (PLEASE CHECK ONE)
CORPORATION
SOLE PROPRIETORSHIP
PARTNERSHIP
LIMITED LIABILITY COMPANY
CORPORATION NAME
DOING BUSINESS AS NAME (DBA)
BUSINESS STREET ADDRESS
CITY, STATE, ZIP CODE
NATURE OF BUSINESS
MO TAX IDENTIFICATION NUMBER
FEDERAL EMPLOYER IDENTIFICATION NUMBER
___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___
DOES BUSINESS HAVE EMPLOYEES IN MISSOURI?
MISSOURI UNEMPLOYMENT INSURANCE COMPENSATION NUMBER
YES
NO
MO CORPORATION CHARTER NUMBER
HOME STATE OF INCORPORATION
BEGIN DATE DOING MO BUSINESS / CERTIFICATE OF AUTHORITY IN MO
IF A CORPORATION
__ __ __ __ __ __ __ __ __ __
__ __ / __ __ / __ __ __ __
A corporation is liable to pay franchise tax if Line 6A or 6B on the Franchise Tax Report is more than $200,000 for years beginning on or after January 1,
1988 through December 31, 1999. Is your corporation liable for Franchise Tax for these years?
YES
NO
IF NO, STATE YEAR(S) WHICH ARE NOT REQUIRED TO BE FILED _____________________________________________
For years beginning on or after January 1, 2000, if the assets of the corporation are less than or equal to $1,000,000 a franchise tax is not due, however, it is
mandatory that a Franchise Tax Return be filed.
Did the corporation have a prior name?
YES
NO
If yes, please state the previous name __________________________________________________________________________
Does the corporation file a consolidated corporation income tax return in Missouri?
YES
NO
If yes, give parent name/FEIN _________________________________________________________________________________
HUSBAND’S SOCIAL SECURITY NUMBER
WIFE’S SOCIAL SECURITY NUMBER
IF A SOLE PROPRIETORSHIP
__ __ __ - __ __ - __ __ __ __ __
__ __ __ - __ __ - __ __ __ __ __
Have you filed individual income tax returns in other states?
NO
YES
If “yes”, what years? ________________________________________________
Have you resided in state(s) where no income tax return is required?
NO
YES
If “yes”, what state(s)? ______________________________________________
If “yes”, what year(s)? ______________________________________________
If “no” explain: __________________________________________________________________________________________________________________________________
How long have you been a Missouri resident? _________________________________________________________________________________________________________
Please attach a listing showing partner’s names, home addresses, and social security numbers/federal employer
IF A PARTNERSHIP
identification numbers.
MISSOURI CIGARETTE WHOLESALER LICENSE NUMBER
MISSOURI MOTOR FUEL LICENSE NUMBER
The Department of Revenue will process your tax clearance and notify you regarding the status of your account. Please note that if the taxpayer owes any
taxes it will be shown on the denial of tax clearance letter issued by the department. This denial of tax clearance will be sent to the person authorized to
receive the tax clearance letter. If your account is clear, a certificate of tax clearance will be issued by the Department of Revenue.
If the requestor is other than an officer of the corporation, the Authorization for Release of Confidential Information section below must be completed before
any information can be disclosed.
SIGNATURE
Under penalties of perjury I declare that the above information is true, accurate, and complete.
SIGNATURE OF OWNER/OFFICER
TITLE
TELEPHONE NUMBER
(__ __ __) __ __ __ - __ __ __ __
AUTHORIZATION FOR RELEASE OF CONFIDENTIAL INFORMATION
Release of this information to a third party 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 represent the taxpayer before the department, it is necessary for the taxpayer to execute a Power of Attorney designating the third party as its representative.
NAME
TITLE
REPRESENTING
ADDRESS
CITY, STATE, ZIP CODE
PLEASE SEND ORIGINAL TO: MISSOURI DEPARTMENT OF REVENUE, TAXATION BUREAU, P.O. BOX 295, JEFFERSON CITY, MO 65105-0295
This publication is available upon request in alternative accessible format(s).
MO 860-2785 (11-2007)

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