Form Mo-1nr - Income Tax Payments For Nonresident Individual Partners Or S Corporation Shareholders - 2015

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Missouri Department of Revenue
Form
2015 Income Tax Payments for Nonresident
MO-1NR
Individual Partners or S Corporation Shareholders
For calendar year 2015 or fiscal year beginning _________________, 2015 and Ending _____________________ , 2016
Name of Partnership or S Corporation
Missouri Tax ID Number
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Address
Federal Employer ID Number
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City or Town
State
Zip Code
r
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Type of entity filing this return:
Partnership
S Corporation
r
Limited Liability Company (Treated as a Partnership)
r
Select if filing under extension (see instructions)
Number of Statement of Income Tax Payments for Nonresident Individual Partners or
S Corporation Shareholders forms
(Form(s)
MO-2NR) attached ..................................... 1
00
Total Missouri income tax withheld (total of all Form(s) MO-2NR) .................................... 2
Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct. I
have direct control, supervision, or responsibility for filing this report and payment of the tax due.
Signature
Title
Phone Number
(
)
-
___ ___ ___
___ ___ ___
___ ___ ___ ___
E-mail Address
Date (MM/DD/YYYY)
___ ___ / ___ ___ / ___ ___ ___ ___
Attach a copy of each Form MO-2NR issued. Make your check payable to the Missouri Department of Revenue. If you pay by check,
you authorize the Department of Revenue to process the check electronically. Any check returned unpaid may be presented again
electronically.
Form MO-1NR (Revised 12-2015)
Mail to:
Taxation Division
Phone: (573) 751-3505
P.O. Box 555
TTY: (800) 735-2966
Visit
Jefferson City, MO 65105-0555
Fax: (573) 526-7939
for additional information.
E-mail:
income@dor.mo.gov

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