Form Int-5 - Farmer'S Cooperative Credit Associations Intangible Property Tax Return - 2007 Page 2

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INSTRUCTIONS
This return is to be filed by all Farmer’s Cooperative Credit Associations authorized to do business in Missouri.
PART III
STATE OF MISSOURI
ss
COUNTY OF
We, the undersigned
, as President, and
, as Secretary of
Association, a corporation organized under an Act of Congress known as the Farm Credit Act of 1933 with its principal office at
,
Missouri, each being first duly sworn upon our separate oaths state that the statements made in the above return are true; that the principal
business of said Association during 2007 was the extension of agricultural credit to its members; that said Association, by authority of
a resolution of its Board of Directors, has elected to absorb and pay these taxes without charging the same to the accounts of its
individual members.
PRESIDENT
SECRETARY
NOTARY INFORMATION
AFFIX SEAL IN THIS BOX
STATE OF
COUNTY OR CITY OF
SWORN TO AND SUBSCRIBED BEFORE ME THIS
DAY OF
, 20
MY COMMISSION EXPIRES
NOTARY PUBLIC
__ __ / __ __ / __ __ __ __
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.
I 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.
PREPARER’S SIGNATURE (OTHER THAN TAXPAYER)
DATE
__ __ / __ __ / __ __ __ __
PREPARER’S ADDRESS AND ZIP CODE
FEIN OR PTIN
MO 860-1141 (11-2007)
DOR-INT-5 (11-2007)

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