Form Mo-96 - Annual Summary And Transmittal Of Missouri Forms Mo-99 Misc

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MISSOURI DEPARTMENT OF REVENUE
FORM
20
TAXATION DIVISION
MO‑96
P O BOX 2200, JEFFERSON CITY, MO 65105-2200
ANNUAL SUMMARY AND TRANSMITTAL OF MISSOURI FORMS MO‑99 MISC.
(REV. 01-2012)
NOTE: Enter the total number of Federal 1099‑MISC forms if substituted for the Missouri Form MO‑99 MISC.
All documents are: (Place an “X” in the proper boxes.)
ENTER
NUMBER OF
WITH TAXPAYER
WITHOUT TAXPAYER
ORIGINAL
CORRECTED
DOCUMENTS
IDENTIFYING NO.
IDENTIFYING NO.
Do not enter hyphens in ID number
PAYER’S identifying number
Mail to: Missouri Department of Revenue
P.O. Box 2200
Jefferson City, Missouri 65105-2200
I have direct control, supervision or responsibility for filing this return. Under penalties of perjury, I declare
it is a true, accurate and complete return. In the case of documents without recipients’ identifying numbers
I have complied with the requirements of the law by requesting such numbers from the recipients, but did
Type or Print PAYER’S name, address, and ZIP code above.
not receive them.
SIGNATURE
TITLE
DATE
__ __ / __ __ / __ __ __ __

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