Form Mo-Qjp - Quality Jobs Program Employers Withholding Report

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MISSOURI DEPARTMENT OF REVENUE
FORM
(573) 751-5759
TAXATION DIVISION
MO-QJP
PO BOX 3375, JEFFERSON CITY, MO 65105-3375
TDD 1-800-735-2966
QUALITY JOBS PROGRAM
FAX (573) 522-6816
(REV. 08-2012)
withholdingproject@dor.mo.gov
EMPLOYERS WITHHOLDING REPORT
BUSINESS NAME
MO. TAX I.D. NUMBER (MITS NO.)
OWNER’S NAME
FEDERAL EMPLOYER I.D. NUMBER (FEIN)
CITY, STATE, ZIP CODE
TAX PERIOD (EXAMPLE: 2012/01)
INSTRUCTIONS FOR COMPLETING FORM MO-QJP
Form MO-QJP must be submitted using the same frequency that you file Form MO-941.
Your completed Form MO-941 must accompany this form, unless electronically filed.
1.
Enter the Department of Economic Development (DED) Project/Product Number assigned to each DED approved Quality Jobs Program jobs
location and the facility address.
2.
Enter the amount of withholding tax retained at each facility address for this reporting period. Use the back of this form.
3.
In Box A, enter the sum of the withholding tax retained from all DED approved locations.
4.
In Box B, enter the amount of withholding tax submitted on line one of Form MO-941 or the amount you electronically filed.
5.
In Box C, enter the sum of Boxes A and B. This is the total amount of tax withheld from your employees.
6.
Sign this form, print your name, include a phone number, and e-mail address where you can be reached.
Important:
F orm MO-941 should be completed after you have determined the amount of withholding tax you are allowed to retain and should only
contain the amount of withholding tax you are not allowed to retain.
C ompensation on Form MO-941, Line 2 may be taken only on the amount of withholding tax you are not allowed to retain.
S ubmit Form MO-QJP at the same filing frequency and at the same time that you are required to submit Form MO-941. For example, if you
are a monthly filer of Form MO-941, you must also complete Form MO-QJP on a monthly basis. Even if you are allowed to retain 100% of your
withholding tax you must still complete and submit Form MO-941 showing $0.00 tax withheld.
If you did not retain the correct amount of tax prior to filing Form MO-941, you must amend your filing with Form MO-941C before
your Quality Jobs claim will be accepted.
WITHHOLDING TAX RETAINED
DED PROJECT/PRODUCT NO.
FACILITY ADDRESS
WITHHOLDING RETAINED
$
DED PROJECT/PRODUCT NO.
FACILITY ADDRESS
WITHHOLDING RETAINED
$
DED PROJECT/PRODUCT NO.
FACILITY ADDRESS
WITHHOLDING RETAINED
$
DED PROJECT/PRODUCT NO.
FACILITY ADDRESS
WITHHOLDING RETAINED
$
DED PROJECT/PRODUCT NO.
FACILITY ADDRESS
WITHHOLDING RETAINED
$
A.
0.00
TOTAL AMOUNT RETAINED FOR TAX PERIOD ................................................................................
$
B.
WITHHOLDING TAX LIABILITY FROM LINE 1 OF FORM MO-941 (or amount electronically filed) ....
$
C.
0.00
$
TOTAL AMOUNT OF WITHHOLDING TAX FOR TAX PERIOD (Sum of Boxes A and B) ................
I declare under penalties of perjury that I employ no illegal or unauthorized aliens as defined under federal law and that I am not eligible for any tax exemption, credit or
abatement if I employ such aliens. I also declare that if I am a business entity, I participate in a federal work authorization program with respect to the employees working
in connection with any contracted services, and I do not knowingly employ any person who is an unauthorized alien in connection with any contacted services.
SIGNATURE
PRINTED NAME
PHONE NUMBER
( __ __ __ ) __ __ __ - __ __ __ __
E-MAIL ADDRESS
DATE (MM/DD/YYYY)
_ _ / _ _ / _ _ _ _
For more information, visit
MO-QJP (08-2012)

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