MISSOURI DEPARTMENT OF REVENUE
FORM
PERSONNEL SERVICES BUREAU
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4349
LETTER OF INTENT FOR SUBSTITUTE TAX FORMS
(REV. 09-2011)
(Personal, Corporate, S Corporate, Sales, Fiduciary, etc.)
COMPANY/INDIVIDUAL’S NAME
IDENTIFICATION CODE (ALPHA CHAR.)
COMPANY REPRESENTATIVE / MANAGER
TELEPHONE NUMBER
VENDOR ID CODE (3-DIGIT NUMBER)
FAX NUMBER
E-MAIL ADDRESS
PRODUCT NAME
ARE YOU A SECONDARY SOFTWARE
WHAT COMPANY IS SUPPLYING THE FORMS TO YOU?
COMPANY FOR SUBSTITUTE FORMS?
(PRIMARY SOFTWARE COMPANY)
YES
NO
STREET ADDRESS
CITY
STATE
ZIP CODE
TECHNICAL SUPPORT TELEPHONE NUMBER
CUSTOMER SERVICE TELEPHONE NUMBER
The Department of Revenue (Department) prescribes the format of income tax returns, schedules, statements, and
declarations as provided in
Section 143.971,
RSMo. The Department has established guidelines for substitute and
reproduced income tax forms for developers of computer software, computer tax processors, computer programmers,
commercial printers, business forms companies and others who plan to market and/or distribute substitute income tax
forms in any manner. These guidelines are at
Applicant’s Certification:
I hereby certify that I am a duly-appointed representative of the company listed above and that we will comply with the
polices, procedures, and guidelines published by the Missouri Department of Revenue concerning the development and
reproduction of substitute tax forms that are produced in any way by products sold or offered by this company.
I agree that this company will:
1. Develop substitute tax forms or products that produce tax forms in accordance with the
Guidelines
issued by the
Department;
2. Submit substitute tax forms to the Department for review and written approval before releasing any substitute tax
forms or any products that produce such forms to customers or clients;
3. Promptly correct errors in the company’s products and substitute tax forms and provide the Department with proofs
(as described in the Department’s Guidelines) showing that the company has corrected the errors and notified
customers or clients of the corrections;
4. Identify all substitute tax forms by the company identification code shown above; and
5. Submit all forms for approval by February 15th to:
E-mail:
piccforms@dor.mo.gov
or
Mail:
Missouri Department of Revenue
301 West High Street - Room 225
Attention: Michelle/Kris
Jefferson City, MO 65105
Failure to follow the guidelines may result in completed income tax forms being rejected by the Department.
SIGNATURE
TITLE
DATE
MO 860-2533 (09-2011)
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