Form Rd-105 - Business License Renewal Page 2
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1
2RD-105
City of Kansas City, Missouri - Revenue Division
BUSINESS LICENSE RENEWAL
(12/15)
Legal Name:
SSN/FEIN:
Account ID:
2016 BUSINESS LICENSE TAX ESTIMATION
Page 2
DOLLARS
CENTS
12. Amount of estimated gross receipts for 2016
12
$
.
13. Tax due based on estimated gross receipts for 2016
(Use the instruction sheet's fee tables to determine based on the company's type
.
of business/NAICS code)
13
$
14. Credit carryforward from 2015 (Amount listed on Line 8)
14
$
.
.
15. Tax due 2016 (Line 13 minus Line 14)
15
$
16a. Penalty: "Failure to file return timely"
.
(5% of the outstanding tax due per month until filed-maximum penalty of 25%)
16a
$
16b. Penalty: "Failure to pay amount due"
(5% of the outstanding tax due)
16b
$
.
17. Interest: "Failure to pay amount due timely"
.
(3% per annum or 0.25% per month until tax is paid)
17
$
18. Amount due for 2016 (Lines 15 plus Line 16a, 16b & 17)
18
$
.
19. Total Amount due (Line 7 plus Line 18)
19
$
.
.
20. Amount Paid
20
$
21. Number of Employees at KCMO location
21
Notes:
Attach all required clearances (Workers' compensation required of construction applications).
DO NOT SEND CASH. Make check payable to: KCMO City Treasurer
Mail to: City of Kansas City, Missouri, Revenue Division, PO Box 843956 Kansas City, MO 64184-3956
I authorize the Commissioner of Revenue or delegate to discuss my return and attachments with my preparer.
Yes
No
Under penalties of perjury, I declare this return to be true, correct, and complete accounting for the taxable year stated.
Date
Phone
Print Name of Taxpayer
Signature
Title
Date
Phone
Preparer Name (if other than taxpayer)
Signature
Title
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