Form Rd-100 - Registration Application
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1City of Kansas City, Missouri - Revenue Division
RD-100
REGISTRATION APPLICATION
(09/15)
Phone:
(816) 513-1120
Fax:
(816) 513-1264
E-file:
kcmo.gov/quicktax
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)
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
Type
Type of Business
Classification of Business
Finance
Profit
Individual
Retail Trade
Limited Liability Company
Wholesale Trade
Real Estate
Non-profit (if non-profit,
attach copy of exemption certificate)
Corporation
Manufacturing
Service
Hotel/Motel
Partnership
Construction
Voluntary Withholding Only
# of rooms:_______
(Non resident Employers)
Other, specify:
Governmental
Other, specify:
Restaurant
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
Mail to: City of Kansas City, Missouri, Revenue Division, 1118 Oak St., Kansas City, MO 64106
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 true, correct, and complete accounting for the taxable year stated.
Signature
Title
Date
Phone
Print Name of Taxpayer
Signature
Title
Date
Phone
Preparer Name (if other than taxpayer)
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Parent category: Business