Form 4379a - Request For Information Of Local License Renewal Current/delinquent Records Page 2
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1
2REQUEST FOR INFORMATION OF LOCAL
LICENSE RENEWAL CURRENT/DELINQUENT RECORDS
Sections 32.057 and 144.121, RSMo allow the Missouri Department of Revenue to release sales and local option use tax information to
political subdivisions that have imposed a sales or local option use tax. It is important to note that this tax information is confidential and
may only be used according to the provisions of Section 32.057, RSMo.
To receive this tax information, the appropriate authorized chief executive of your political subdivision must complete, notarize and sign
the Missouri Department of Revenue Form 4379A. You must identify the person authorized to receive this information on behalf of the
political subdivision. If more than one person is authorized to receive this information, please identify each person. If the person autho-
rized to receive this information changes, complete a new form.
In order to ensure that your request will be processed in time for your renewal, mail or fax the completed form one month before you
would like to receive the printouts and have the Department of Revenue notify delinquent taxpayers. If this form is not properly
completed, we will return it for the additional information.
Please return the completed form to the Missouri Department of Revenue, Customer Services Division, P.O. Box 3666, Jefferson City,
Missouri 65105-3666 or fax it to (573) 522-1160. If you have questions regarding your request or we may be of other assistance, please
contact the Customer Services Division at the above address or call (573) 751-9268.
The Department of Revenue can also assist you in other matters relating to the collection and administration of your sales and local
option use tax. For more information about the types of reports available or for the cost of these reports, contact the Information
Systems Division, P.O. Box 41, Jefferson City, Missouri 65105-0041 or call (573) 751-4391.
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