Fillable Form Int-4 - Credit Union Tax Return

Form Int-4 - Credit Union Tax Return - 2007 Page 2

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SCHEDULE A — TAXES CLAIMED AS CREDITS

DESCRIPTION (Do not list real estate taxes or tangible personal property tax on leased property)

AMOUNT

Total (Enter on Lines 4 and 14, Page 1)

SCHEDULE B — POLITICAL SUBDIVISIONS TAXING THE REPORTING CREDIT UNION

This section must be completed by credit unions with only one office. If you have more than one office location, you must complete the Financial

Institution Tax Schedule B, Form 2331. Information available from your real or personal property tax receipt.

PHYSICAL STREET ADDRESS

CITY, STATE, ZIP CODE

SUBDIVISIONS

NAME OR NUMBER

County

City

Road District

School District

Library District

Water District

Sewer District

Fire District

Township/Other Tax Districts

AUTHORIZATION/NON-AUTHORIZATION

I authorize the Director of Revenue or his/her

I do NOT authorize the Director of Revenue or his/

PREPARER’S TELEPHONE

delegate to discuss my return and attachments with

her delegate to discuss my return and attachments

the preparer or any member of his/her firm.

with the preparer or any member of his/her firm.

SIGNATURE — PLEASE SIGN BELOW

, whose return is herewith submitted, declare that we have read and are familiar with all

of the statements contained in this return, including the accompanying schedules (if any) all of which are true and correct, according to our

best knowledge and belief, and that this return is a true and complete statement, in accordance with the law, for the taxable year covered.

I also declare under penalties of perjury that I employ no illegal or unauthorized aliens as defined under federal law and that I am not

eligible for any tax exemption, credit or abatement if I employ such aliens.

SIGNATURE OF OFFICER

DATE

PREPARER’S SIGNATURE (OTHER THAN TAXPAYER)

DATE

__ __ / __ __ / __ __ __ __

TITLE OF OFFICER

PHONE NUMBER

PREPARER’S ADDRESS AND ZIP CODE

FEIN OR PTIN

(_ _ _) _ _ _ - _ _ _ _

DOR-INT-4 (11-2007)

MO 860-1643 (11-2007)

Form Int-4 - Credit Union Tax Return - 2007 Page 2

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