Form Mo-99 Misc - Information Return For Receipts Of Miscellaneous Income - State Of Missouri

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Missouri Department of Revenue

Form

Information Return For Receipts of

Miscellaneous Income

MO-99 MISC

20___

Name

Tax Identification Number

Address

City

State

ZIP Code

* If account is for multiple payees with different surname or it includes the name of a fiduciary, trust, or estate, place an asterisk (*) by the name of the

individual or entity to whom the identifying number belongs.

Name

Tax Identification Number

Address

City

State

ZIP Code

Commissions and Fees to Nonemployees (No Form W-2 Items)

Other Fixed or Determinable Income (Specify)

Prizes and Awards to Nonemployees (No Form W-2 Items)

Rents

Royalties