Form 4458 - Business Activity Questionnaire
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MISSOURI DEPARTMENT OF REVENUE
FORM
TAXATION DIVISION
4458
P.O. BOX 295, JEFFERSON CITY, MO 65105-0295
(573) 522-3732
(REV. 08-2010)
BUSINESS ACTIVITY QUESTIONNAIRE
NAME OF BUSINESS
ADDRESS
CITY, STATE, ZIP
OWNERSHIP TYPE
DATE OF INCORPORATION
STATE OF INCORPORATION
STATE OF COMMERCIAL DOMICILE
DATE ACTIVITY BEGAN IN MISSOURI
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
PRINCIPAL BUSINESS ACTIVITY:
MISSOURI TAX I.D. NUMBER
FEDERAL I.D. NUMBER
__ __ __ __ __ __ __ __
__ __ __ __ __ __ __ __ __
NATURE OF BUSINESS ACTIVITY IN MISSOURI:
CHARTER NUMBER
BUSINESS TELEPHONE NUMBER
(__ __ __) __ __ __ - __ __ __ __
OTHER STATES THAT THE COMPANY CONDUCTS BUSINESS IN:
For the purpose of this questionnaire, representatives shall include employees, agents, independent contractors, brokers or others that
reside in, or regularly and systematically enter into, this state on your behalf.
1. How are deliveries made? By common carrier
By your vehicles
If so, are such vehicles owned or leased?
2. Have returns been filed with this office for any prior years by the above-named firm or any subsidiary or affiliates? Yes
No
If so, Missouri Identification Number
3. Do you currently have or at any time had: an office
, agency
, warehouse
or other place of business in Missouri?
Yes
No
If yes, please provide the following information for each establishment (use additional sheets if necessary):
a) Location:
b) Approximate beginning date of operation:
c) Nature of business activity:
d) Telephone number listed in a directory in this state:
4. Does your company or affiliated company currently hold title or in the past, held title, to any tangible property located in Missouri?
(Such as merchandise inventories, motor vehicles, office or industrial equipment, etc.)
Yes
No
If yes, briefly describe property, and state for what years it was held in Missouri:
In what name was it licensed or listed for tax purposes?
5. Amount of real or tangible personal property in Missouri for the last four years:
20 ______
20 ______
20 ______
20 ______
Inventory
$
$
$
$
Other owned property
$
$
$
$
Rental property (annual rent)
$
$
$
$
Total
$
$
$
$
6. Address where principal amount of inventory in Missouri is located:
7. Address and description of principal amount of other property in Missouri:
8. Address and telephone number of all offices, displays or sample rooms you maintain in Missouri:
This publication is available upon request in alternative accessible format(s).
MO 860-2629 (08-2010)
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Parent category: Financial