Form Int-3 - Savings And Loan Association - Building And Loan Association Tax Return - 2015 Page 2
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1
2Description (Do not list tangible personal property tax on leased property)
Amount
Total (Enter on Lines 7 and 17, Page 1)
I authorize the Director of Revenue or delegate to discuss my return and attachments with the preparer or any
r
r
member of his or her firm, or if internally prepared, any member of the internal staff ..............................................
Yes
No
Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct.
Declaration of preparer (other than taxpayer) is based on all information of which he or she has any knowledge.
Signature of Officer (Required)
Title of Officer
Phone Number
Date (MM/DD/YYYY)
(
)
-
__ __ /__ __ /__ __ __ __
___ ___ ___
___ ___ ___
___ ___ ___ ___
Preparer’s Signature (Including Internal Preparer) Preparer’s FEIN, SSN, or PTIN
Phone Number
Date (MM/DD/YYYY)
(
)
-
__ __ /__ __ /__ __ __ __
___ ___ ___
___ ___ ___
___ ___ ___ ___
Make check or money order payable to “Missouri Department of Revenue”. Mail completed form and attachments to the address below.
If you pay by check, you authorize the Department of Revenue to process the check electronically. Any returned check may be presented
again electronically.
Form INT-3 (Revised 12-2015)
Mail to:
Visit
Taxation Division
Phone: (573) 751-2326
P.O. Box 898
TTY: (800) 735-2966
for additional information.
Jefferson City, MO 65105-0898
Fax: (573) 522-1721
E-mail:
fit@dor.mo.gov
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