Fillable Form 943t - Request For Tax Clearance For Transient Employers printable pdf download

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Missouri Department of Revenue

Form

943T

Request for Tax Clearance for Transient Employers

Missouri Tax Identification Number

Federal Tax Identification Number (FEIN)

Charter or Certificate of Authority Number

Home State of Incorporation

Begin Date Doing Missouri Business or Certificate of Authority in Missouri

__ __ /__ __ /__ __ __ __

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

Yes

2. Does the business have non-resident employees working in Missouri?

Yes

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

Yes

If yes, what is that account number? _______________________

Note: If there has been a change in the ownership of your business, contact the Taxation Division at the telephone number

below to ensure your account is properly registered prior to requesting a Tax Clearance.

Corporation

Partnership

Sole Proprietorship

Limited Liability Company — Taxed as (select one)

Corporation

Sole Owner

Partnership

Name of Business or Corporation

Doing Business As (DBA)

Business Mailing Address

City

State

Zip Code

Contact Person Phone Number

Contact Person E-mail Address

( ___ ___ ___ ) ___ ___ ___ - ___ ___ ___ ___

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

_______________________________________________________________________________________________

This corporation files consolidated corporation income tax returns in Missouri.

a. Parent corporation’s FEIN that returns are filed under

b. Missouri Tax Identification Number of the parent corporation

Federal Tax Identification Number (FEIN)

Missouri Tax Identification Number

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

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

Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct.

Signature of Owner or Officer

Printed Name

Title

Telephone Number

Date (MM/DD/YYYY)

(

)

___ ___ ___

___ ___ ___ ___

___ ___ / ___ ___ / ___ ___ ___ ___

Form 943T (Revised 06-2013)

Mail to:

Taxation Division

Phone: (573) 751-0459

Visit

Fax: (573) 522-1722

P.O. Box 357

for additional information.

E-mail: nexus@dor.mo.gov

Jefferson City, MO 65105-0357

Form 943t - Request For Tax Clearance For Transient Employers

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