Form 1746 - Missouri Sales Or Use Tax Exemption Application - 2015 Page 2
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2Record Storage Address (Do not use P.O. Box or Rural Route)
Street Address (Do not use P.O. Box or Rural Route)
City
State
Zip Code
County
Name (Last, First, Middle Initial)
Title
Social Security Number
Birthdate
(MM/DD/YYYY)
___ ___ / ___ ___ / ___ ___ ___ ___
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Street Address
City
State
Zip Code
Name (Last, First, Middle Initial)
Title
Social Security Number
Birthdate
(MM/DD/YYYY)
___ ___ / ___ ___ / ___ ___ ___ ___
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Street Address
City
State
Zip Code
In one or two brief statements, summarize the primary organizational purpose and the main activities. Explain the intended use of the exemption
letter.
Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct; that the present
nature, purpose and activities of the above-named organization or agency are the same as they were when the attached documents were issued
and will continue to remain the same; that I will remain knowledgeable of the statutes and regulations governing sales or use tax exemptions and
that I will immediately notify the Department of any change in circumstances which could reasonably lead me to believe that the above-named
organization or agency would no longer qualify as exempt, either because of a change in the law or because of a material change in the
organization’s or agency’s nature, purpose, or activities.
It is understood that any misrepresentation contained herein or failure on my part to fulfill the promises entered into here will result in the
immediate revocation of any exemption letter issued to this organization or agency.
An officer, member, or responsible person must sign the application. If a power of attorney signs the application, you must include a Power of
Attorney
(Form
2827) signed by an officer, member, or responsible person listed on the application.
Signature of Officer or Responsible Person
Title
Printed Name
E-mail Address
Social Security Number
Date of Birth (MM/DD/YYYY)
Date (MM/DD/YYYY)
___ ___ / ___ ___ / ___ ___ ___ ___
___ ___ / ___ ___ / ___ ___ ___ ___
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Missouri Statute
32.057,
RSMo, states that all tax records and information maintained by the Department are confidential. The
tax information can only be given to the owner, partner, member, or officer who is listed with us as such. If you wish to give an
employee, attorney, or accountant access to your tax information, you must supply us with a power of attorney giving us the
authority to release confidential information to them.
If your officers, members, or responsible persons change, you must update your registration with the Department by completing
a Registration or Exemption Change Request
(Form
126), before we can release tax information to those new officers,
members, or responsible persons.
Form 1746 (Revised 08-2015)
Mail to:
Taxation Division
Phone: (573) 751-2836
Visit
dor.mo.gov/business/sales/
P.O. Box 358
TTY: (800) 735-2966
for additional information.
Jefferson City, MO 65105-0358
Fax: (573) 522-1271
E-mail:
salestaxexemptions@dor.mo.gov
*14013020001*
14013020001
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