Form 1315a - Monthly Statement Of Collections
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MISSOURI DEPARTMENT OF REVENUE
Use this form to certify monthly collections to
FORM
TAXATION DIVISION
the Director of Revenue. If collector fails to file
1315A
P.O. BOX 453, JEFFERSON CITY, MO 65105-0453
his or her monthly statements with the county
(573) 751-5900
TDD 1-800-735-2966
clerk, the county clerk should notify the Director
MONTHLY STATEMENT OF COLLECTIONS
(REV. 09-2010)
of Revenue and the Prosecuting Attorney.
I,
, Clerk of the County Commission within and for the
County of
, hereby certify to the Director of Revenue, that from the
monthly statement filed in my office, and sworn to by
Collector of the State and County revenue within and for said County, it appears that he has collected for State purposes during the month
of
, 20
, the following amounts:
GROSS COLLECTIONS MUST BE REPORTED IN ALL CASES
CURRENT TAXES AND LICENSES
TAX
INTEREST
TOTAL
LAND TAX, 2011
$
$
$
PERSONAL TAX, 2011
LICENSE COLLECTION
UTILITY
RAILROAD
PAYMENT IN LIEU OF TAXES
PROTEST
SUR TAX
TOTAL CURRENT COLLECTIONS
$
$
$
BACK TAX COLLECTIONS
LAND, 2010
$
$
$
LAND, 2009
LAND, 2008
LAND, 2007
LAND, 2006
LAND, 2005
TOTAL BACK LAND
$
$
$
PERSONAL, 2010
$
$
$
PERSONAL, 2009
PERSONAL, 2008
PERSONAL, 2007
PERSONAL, 2006
PERSONAL, 2005
TOTAL BACK PERSONAL
$
$
$
TOTAL BACK TAX COLLECTIONS
$
$
$
GRAND TOTAL COLLECTIONS
$
$
$
WITNESS MY HAND AND OFFICIAL SEAL
DONE AT MY OFFICE IN
THIS
DAY OF
20
CLERK OF THE COUNTY COMMISSION
DISTRIBUTION: WHITE — DEPARTMENT OF REVENUE, YELLOW AND PINK — COUNTY COURTHOUSE
MO 860-0052 (09-2010)
This publication is available upon request in alternative accessible format(s).
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Parent category: Financial