Fillable Form 943 - Request For Tax Clearance printable pdf download

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MISSOURI DEPARTMENT OF REVENUE

FORM

REQUEST FOR TAX CLEARANCE

943

Phone: (573) 751-9268

Fax: (573) 522-1265

(REV. 06-2011)

E-mail: taxclearance@dor.mo.gov

COMPLETE FORM IN ITS ENTIRETY TO OBTAIN A TAX CLEARANCE

MO TAX IDENTIFICATION NUMBER OR EXEMPTION NUMBER FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN)

CHARTER NUMBER/CERTIFICATE OF AUTHORITY NUMBER

__ __ __ __ __ __ __ __

__ __ __ __ __ __ __ __ __

__ __ __ __ __ __ __ __ __ __

1. Does this business have Missouri employees for which they are required to withhold Missouri taxes?

YES

2. Do you pay contributions to the Division of Employment Security?

YES

NO If yes, what is that account number? ______________

If there has been a change in the ownership of your business, you may need to contact Business Tax Registration at

TYPE OF OWNERSHIP

(573) 751-5860 to ensure your account is properly registered.

CORPORATION

SOLE PROPRIETORSHIP

PARTNERSHIP

LIMITED LIABILITY COMPANY — How are you taxed? (check one)

As a corporation

As a sole owner

As a partnership

MAILING ADDRESS OF BUSINESS

(NOTE: This is where the correspondence will be mailed, if the Authorization for Release of Confidential Information Section below is not completed.)

NAME OF BUSINESS OR CORPORATION

DOING BUSINESS AS NAME (DBA)

BUSINESS MAILING ADDRESS

CITY, STATE, ZIP CODE

It is not necessary to type hypens or dashes.

CONTACT PERSON

CONTACT PHONE NUMBER

( __ __ __ ) __ __ __ - __ __ __ __

REASON FOR REQUEST (Check all that apply)

1. I am completing the following transaction with the Missouri Secretary of State’s Office.

Please check the appropriate box(es).

__ __ / __ __ / __ __ __ __

Reinstatement

Withdrawal/Termination

Merger — Date of Merger

All tax types and the account with the Division of Employment Security will be reviewed and must be filed and paid in full.

2. I am completing the following transaction:

Please check the appropriate box(es).

Selling Business Assets

Financial Closing

MBE/WBE

Missouri Quality Jobs

Other ___________________

All tax types and the account with the Division of Employment Security will be reviewed and must be filed and paid in full.

3. I require a sales/use tax Certificate of No Tax Due for the following:

Please check the appropriate box(es).

Business License

Liquor License

Other (if not listed) ____________________________________________________

4. I require a sales/use tax Vendor No Tax Due to obtain or renew a contract with the State of Missouri.

Please provide the contact person and phone number where they can be reached.

( __ __ __ ) __ __ __ - __ __ __ __

Name: _______________________________________________________ Phone Number:

If there has been a name change for this corporation, please provide the prior name.

CORPORATIONS

_______________________________________________________________________________________________

This corporation files consolidated corporation income tax returns in Missouri.

a. The parent corporation’s FEIN that these returns are being filed under is: ___ ___ ___ ___ ___ ___ ___ ___ ___

b. The Missouri Tax Identification Number of the parent corporation is: ___ ___ ___ ___ ___ ___ ___ ___

Missouri corporation franchise tax returns cannot be filed consolidated and must be filed by each corporation.

YOUR SOCIAL SECURITY NUMBER

SPOUSE’S SOCIAL SECURITY NUMBER

SOLE PROPRIETORSHIPS

__ __ __ - __ __ - __ __ __ __

If individual income tax returns have previously been filed in another state, please provide a list of the states and years filed.

Authorization for Release of Confidential Information: All correspondence will be released to the person authorized below. Release of this information to a third party

(such as an accountant) at the request of the taxpayer does not give the third party authority to request further information from the department. To obtain additional information or to

represent the taxpayer before the department, the taxpayer must execute a Power of Attorney designating the third party as its representative.

NAME OF PERSON AUTHORIZED TO RECEIVE THIS INFORMATION

TITLE

PHONE NUMBER

( _ _ _ ) _ _ _ - _ _ _ _

ADDRESS

CITY, STATE, ZIP CODE

SIGNATURE OF OWNER, PARTNER, OR CORPORATE OFFICER

Under penalties of perjury I declare that the above information is true and complete.

SIGNATURE OF OWNER/OFFICER

TITLE

PHONE NUMBER