Form 1746 - Missouri Sales/use Tax Exemption Application
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1
2MISSOURI DEPARTMENT OF REVENUE
DIVISION OF TAXATION AND COLLECTION
FORM
P.O. BOX 3380
1746
JEFFERSON CITY, MISSOURI 65105-3380
MISSOURI SALES/USE TAX
(REV. 9-2001)
EXEMPTION APPLICATION
INSTRUCTIONS
MAIL COMPLETED APPLICATION TO:
MISSOURI DEPARTMENT OF REVENUE
TO AVOID POSSIBLE DELAY IN PROCESSING YOUR
DIVISION OF TAXATION AND COLLECTION
APPLICATION, PLEASE:
P.O. BOX 3380
• PRINT OR TYPE.
JEFFERSON CITY, MISSOURI 65105-3380
• DO NOT WRITE IN SHADED AREAS.
(573) 751-2836
TDD 1-800-735-2966
FAX: (573) 522-1160
• ANSWER ALL QUESTIONS COMPLETELY.
E-mail: salesuse@mail.dor.state.mo.us
1. IF YOU HAVE BEEN ISSUED A MISSOURI TAX I.D. NUMBER, ENTER BELOW
EFFECTIVE DATE
M
M
D
D
C
C
Y
Y
2. TYPE OF APPLICATION
CODE
IF RENEWAL, PLEASE ATTACH COPY OF PREVIOUS
NEW
RENEWAL
EXEMPTION LETTER.
3. QUALIFYING FOR EXEMPTION AS: (CHECK ONE)
CHARITABLE
CIVIC
ELEMENTARY OR SECONDARY
PUBLIC EDUCATION
HIGHER EDUCATION OR PRIVATE NOT-FOR-PROFIT
RELIGIOUS
ELEMENTARY AND SECONDARY EDUCATION
POLITICAL SUBDIVISION
SOCIAL, FRATERNAL
STATE OR FEDERAL AGENCY
OTHER
4. IRS EXEMPTION CODE (THIS WOULD NOT APPLY TO POLITICAL SUBDIVISIONS AND STATE AND FEDERAL AGENCIES.)
501(c)(3)
501(c)(4)
501(c)(8)
501(c)(10)
OTHER
ORGANIZATION NAME AND LOCATION
5. ORGANIZATION NAME
STREET ADDRESS OR RURAL ROUTE — DO NOT USE P.O. BOX
PHONE
(
)
CITY
CODE
STATE ZIP CODE
COUNTY
CODE
LEGAL NAME OF RESPONSIBLE PERSON AND ADDRESS
6. LEGAL NAME OF RESPONSIBLE PERSON (LAST, FIRST, MIDDLE INITIAL)
STREET ADDRESS
PHONE
(
)
CITY
STATE
ZIP CODE
COUNTY
CODE
TYPE OF ORGANIZATION
7. TYPE OF ORGANIZATION
(CHECK ONE)
FOUNDATION
ASSOCIATION
GOVERNMENT
OTHER
MISSOURI CHARTER NUMBER
DATE INCORPORATED
MISSOURI CORPORATION
M
M
D
D
C
C
Y
Y
MISSOURI CERTIFICATE OF AUTHORITY NO.
DATE REGISTERED IN MISSOURI
STATE OF INCORPORATION
OUT-OF-STATE CORPORATION
M
M
D
D
C
C
Y
Y
MAILING ADDRESS
8. MAILING ADDRESS (MAY USE P.O. BOX)
ORGANIZATION OR AGENCY ADDRESS
RESPONSIBLE PERSON’S ADDRESS
OTHER (GIVE FULL ADDRESS BELOW):
STREET ADDRESS OR P.O. BOX
CITY
STATE ZIP CODE
COUNTY
CODE
9. ADDRESS OR LOCATION DESCRIPTION OF WHERE BOOKS AND RECORDS ARE KEPT (PLEASE DO NOT USE P.O. BOX OR RURAL ROUTE)
ORGANIZATION OR
RESPONSIBLE
MAILING ADDRESS
OTHER (GIVE FULL ADDRESS BELOW):
AGENCY ADDRESS
PERSON’S ADDRESS
STREET ADDRESS — DO NOT USE P.O. BOX OR RURAL ROUTE
CITY
STATE ZIP CODE
COUNTY
CODE
PLEASE COMPLETE AND SIGN BACK OF APPLICATION
MO 860-2158 (9-2001)
DOR-1746 (9-2001)
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