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

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Missouri Department of Revenue
Form
Tax Year
Annual Summary and Transmittal of Missouri Forms MO-99 Misc.
MO-96
20_____
Enter the total number of Federal 1099-MISC forms if substituted for the Missouri Form MO-99 Misc. ___________________
r
r
r
r
All documents are:
Original
Corrected
With Taxpayer Identifying No.
Without Taxpayer Identifying No.
Name
Identifying Number
Address
City
State
Zip Code
Under penalties of perjury, I declare that the information I have provided is true, complete, and correct. I have direct control, supervision or
responsibility for filing this 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 not receive them.
Signature
Title
Date (MM/DD/YYYY)
__ __ / __ __ / __ __ __ __
Form MO-96 (Revised 09-2013)
Mail to:
Taxation Division
Phone: (573) 751-3505
Visit
P.O. Box 2200
Fax: (573) 751-2195
for additional information.
Jefferson City, MO 65105-2200
E-mail:
income@dor.mo.gov

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