Fillable Form 5310 - Application For Voluntary Disclosure Agreement printable pdf download

Form 5310 - Application For Voluntary Disclosure Agreement

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missouri department of revenue

5310

taxation division

p.o. box 295 jefferson city, mo 65105-0295

ApplicAtion for voluntAry Disclosure Agreement

(rev. 03-2011)

the missouri department of revenue (department) welcomes individuals, partnerships, corporations, etc. who wish to voluntarily disclose

any unpaid taxes administered by the department. entities may approach the department anonymously, through a representative, or other-

wise.

1. applicant is a(n) (select one)

o individual

o c corporation

o s corporation

o partnership

o Limited partnership

o fiduciary

o Limited Liability partnership

o Limited Liability company taxed as a disregarded entity

o Limited Liability company taxed as a partnership

o Limited Liability company taxed as a corporation

2. if the type of business has changed during the last 5 years, indicate the type(s) of the predecessor entities and the periods in which they

existed.

3. What is the applicant’s fiscal year-end?

4. if the fiscal year-end has changed within the past 5 years, please list all fiscal year-ends.

5. What are the applicant’s business activities? example: “a manufacturer of tangible personal property that sells primarily to contractors

who incorporate the material into buildings and landscape designs.”

6. if the applicant makes sales from outside the state to in-state customers, may a customer return the applicant’s product for refund,

exchange, repair, or other value?

o yes o no

if yes, please briefly describe how this is done.

o n/a

7. other than as disclosed above, is the applicant an owner, lessor, or lessee of property in missouri? please describe and include both

real property, personal property, and intellectual property, e.g., trademarks or patents.

8. other than as disclosed above, has the applicant had personnel in missouri for any period of time, whether employees, independent

contractors, affiliates, or other representatives? include all contacts, even if transitory. Generally describe their activities, their

approximate amount of time spent in the state, and their relationship to the applicant, if not previously described.

9. What other activities does the applicant engage in that potentially give rise to nexus?

dor-5310 (03-2011)

Form 5310 - Application For Voluntary Disclosure Agreement

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