Form 126 - Registration Or Exemption Change Request - 2016 Page 3

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Is this business located inside the city limits of any city or municipality in Missouri? For help determining this visit https://dors.mo.gov/tax/strgis/index.jsp.

Yes - Specify the city:

Is this business located inside a district(s)? For example, ambulance, fire, tourism, community, or transportation development.

Yes - Specify the district name(s):

Change Sales and Use Tax Filing Frequency To:

Monthly ($500 or more per month in tax)

Quarterly (Less than $500 per month in tax)

Annually (Less than $100 per quarter in sales tax)

*Continue current filing until this change is verified by the Department.

Do you make retail sales of the following items? Select all that apply.

Alcoholic Beverages

Alternative Nicotine

Cigarettes or Other Tobacco Products

Domestic Utilities

E-Cigarettes or Vapor Products

Food Subject to Reduced State Food Tax Rate

Items Qualifying for Show Me Green Sales Tax Holiday

Items Qualifying for Back-To-School Sales Tax Holiday

Lead-Acid Batteries

Lease or Rent Motor Vehicles

New Tires

Post-Secondary Educational Textbooks

Telecommunication Services

Qualifying Utilities or Items Used or Consumed in Manufacturing or Mining, Research and Development, or Processing Recovered Materials.

Do you make retail sales of aviation jet fuel to Missouri customers? ..............................................................................................

Yes

If yes, are your sales made at:

A Missouri airport

A location outside Missouri and the fuel is transported into Missouri?

If yes, is the airport located in Missouri and identified on the National Plan of Integrated Airport Systems (NPIAS)? .....................

Yes

If yes, provide a list of applicable locations. ________________________________________________________________________________

Do you use, store, or consume aviation jet fuel in Missouri where the seller does not collect tax? .................................................

Yes

If yes, is the fuel stored, used, or consumed in an airport that is identified on the NPIAS? ............................................................

Yes

If yes, provide a list of applicable locations: ________________________________________________________________________________

I would like to change from a transient employer to a regular employer.

(Must have filed 24 consecutive months in Missouri)

Change the corporation taxable year end to:

Change* Withholding Tax Filing Frequency To:

*Continue current

Annually (less than $100 withholding tax per quarter)

filing until this

(MM/DD) __ __ / __ __

Quarterly ($100 withholding tax per quarter to $499 per month)

change is verified

by the Department.

Monthly ($500 to $9,000 withholding tax per month)

Quarter-Monthly (weekly) (over $9,000 withholding tax per month,

required to pay electronically)

Comments

Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct. This form must be signed by the owner, if

the business is a sole ownership; partner, if the business is a partnership; reported officer, if the business is a corporation, or by a member, if the business is an L.L.C.

No digital signatures allowed

as reported on the application.

Signature

Printed Name

Title

Date (MM/DD/YYYY)

___ ___ / ___ ___ / ___ ___ ___ ___

Registration Change

*15600030001*

Mail to:

Taxation Division

Phone: (573) 751-5860