Form Rd-103 - Business License Application Flat Rate
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1BUSINESS LICENSE APPLICATION
Flat Rate
RD-103
Phone
(Rev 08/12)
City of Kansas City, Missouri
(816) 513-1135
Revenue Division
Period From:
Period To:
Legal Name:
FEIN/SSN:
Mailing Address:
Account ID:
DBA Name:
SIC Code:
Business Address:
For changes to name, address or FEIN/SSN, please contact us at or (816) 513-1135.
BUSINESS LICENSE EXPIRES DECEMBER 31 OF EACH YEAR.
TO AVOID PENALTY PAY BEFORE MARCH 1.
Table Number (see last page of instruction booklet)
1. Fee calculation - Enter flat fee and/or flat rate values (from RD103 Flat Fee table)
Missouri Sales Tax No.
a. Units for full year (if not applicable enter 1)
and/or
b. Units part year (if proratable)
x # months
divided by 12 =
c. Total units (1a + 1b)
1c.
(Amended returns should include totals, not just additional units.)
d. Qualifier (if not applicable, enter 1)
1d.
DOLLARS
CENTS
e. Flat rate or Line 1c _______ x rate per unit $_______
1e.
2. Penalty: Please see instructions for penalty calculations
2.
Interest: 3% per annum until tax is paid (add Penalty & Interest together)
3. Annual fee due (sum of lines 1e and 2)
3.
4. Amount Paid
4.
/
/
5. If business closed prior to January 1, ENTER DATE BUSINESS CLOSED
5.
M
M
D
D
Y
Y
6.
6. "X" if amended (line 1a and 1b must be completed)
ATTACH ALL REQUIRED CLEARANCES
Make check payable to: CITY TREASURER. DO NOT SEND CASH Mail to Revenue Division, PO Box 804103 Kansas City, MO 64180-4103
Under penalties of perjury, I declare this return to be a true, correct, and complete accounting for the taxable year stated.
I authorize the Comm issioner of Revenue or delegate to discuss m y return and attachments with m y preparer.
Yes
No
Taxpayer Signature
Print Name
Title
Phone
Date
Preparer Signature (if other than taxpayer)
Print Name
Title
Phone
Date
Draft
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Parent category: Financial