Form 472 - Request For Sales Or Use Tax Cash Bond Refund
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Missouri Department of Revenue
Form
(MM/DD/YY)
472
Request for Sales or Use Tax Cash Bond Refund
Missouri Tax I.D.
Number
Business Name
Amount of Bond Filed (Dollars)
$
Business Address
City
State
Zip Code
Cash Bond has been filed for the required period (two consecutive years) with a satisfactory tax compliance
/
/
Sold or quit business on (MM/DD/YYYY)
___ ___
___ ___
___ ___ ___ ___
Business never opened
Other (Explain)
Name (Check will be issued in the name of the owner(s) listed on the Department’s records)
Telephone Number (Daytime)
-
(
)
___ ___ ___
___ ___ ___
___ ___ ___ ___
Address
City
State
Zip Code
Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct.
I also swear and affirm all returns have been filed and paid and there are no outstanding liabilities.
Signature of Taxpayer
Title
E-mail Address
Date (MM/DD/YYYY)
/
/
___ ___
___ ___
___ ___ ___ ___
1.
$
2.
$
3.
$
0.00
Total Amount Refunded
$
Check Amount
Check Date (MM/DD/YYYY)
Refund Check Number
/
/
___ ___
___ ___
___ ___ ___ ___
Form 472 (Revised 12-2014)
Mail to: Taxation Division
Phone: (573) 751-5860
Visit
P.O. Box 357
TTY: (800) 735-2966
for additional information.
Jefferson City, MO 65105-0357
Fax: (573) 522-1722
E-mail:
businesstaxregister@dor.mo.gov
*14603010001*
14603010001
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