Form 5121 - Complaint Pursuant To Section 115.342, Rsmo

Download a blank fillable Form 5121 - Complaint Pursuant To Section 115.342, Rsmo in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form 5121 - Complaint Pursuant To Section 115.342, Rsmo with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

MISSOURI DEPARTMENT OF REVENUE
Reset Form
Print Form
FORM
GENERAL COUNSEL’S OFFICE
5121
301 WEST HIGH STREET, PO BOX 475
JEFFERSON CITY, MO 65105
(REV 11-2007)
COMPLAINT PURSUANT TO SECTION 115.342, RSMo
I have probable cause to believe that _______________________________________________________,
Candidate's Name (Last, First, Middle)
_____________________________________________________________________________________
Street Address, City, County, State and Zip Code
a candidate for _________________________________________________________________________
Elected Office
has failed to file and pay the following taxes that are due and owing and to my knowledge are not in dispute.
Check all that apply.
State Income Taxes
Personal Property Taxes
Real Property Taxes on his/her Place of Residence
Candidate is or was a corporate officer of a fee office that owes taxes to the state.
The facts upon which I have probable cause to believe a tax or taxes are owed are as follows:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
COMPLAINANT’S SIGNATURE
PRINTED NAME OF COMPLAINANT (LAST, FIRST, MIDDLE)
COMPLAINANT’S RESIDENCE STREET ADDRESS
DAYTIME TELEPHONE (INCLUDING AREA CODE)
CITY, COUNTY, STATE, AND ZIP CODE
State of Missouri, County (and/or City) of ___________________________________________________
City and/or County
on this ______________________ day of _________________________________, 20_____, before me,
_____________________________________________________________________________________,
Notary's Name
a Notary Public in and for said state, personally appeared ______________________________________.
Complainant’s Name
known to me to be the person who executed the within Complaint and acknowledged to me that he or she
executed same for the purposes therein stated.
SEAL
My Commission Expires:___________________________________
Send Complaint and any attachments to:
General Counsel’s Office
Missouri Department of Revenue
P.O. Box 475
301 West High Street
Jefferson City, MO 65105

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form 5121 Complaint Pursuant To Section 115.342, Rsmo Form 5121 Complaint Pursuant To Section 115.342, Rsmo Financial
Sec Form 8-k (pursuant To Section 13 Or 15(d) Of The Securities Exchange Act Of 1934) Sec Form 8-k (pursuant To Section 13 Or 15(d) Of The Securities Exchange Act Of 1934) Legal
Affidavit Form Of Indigence Pursuant To Section 57.085, Florida Statutes - Alachua County, Florida Affidavit Form Of Indigence Pursuant To Section 57.085, Florida Statutes - Alachua County, Florida Legal
Secretary Of State Form 1505 - Certificate Pursuant To Section 1505, California Corporations Code Secretary Of State Form 1505 - Certificate Pursuant To Section 1505, California Corporations Code Legal
Form To-2 - Information To Be Included In Short-term Ownership Information Statements Pursuant To Sections 55.03(3) And 552.03(4), Wis. Stats. - 1996 Form To-2 - Information To Be Included In Short-term Ownership Information Statements Pursuant To Sections 55.03(3) And 552.03(4), Wis. Stats. - 1996 Legal
Form To-1 - Information To Be Included In Long-form Ownership Information Statements, Amendments Or Registration Statement Of Take-over Offer Pursuant To Sections 552.03(1), 552.03(4) And 552.05(2), Wis. Stats. - 1996 Form To-1 - Information To Be Included In Long-form Ownership Information Statements, Amendments Or Registration Statement Of Take-over Offer Pursuant To Sections 552.03(1), 552.03(4) And 552.05(2), Wis. Stats. - 1996 Legal
Form 1 - Application For, And Amendments To Application For, Registration As A National Securities Exchange Or Exemption From Registration - 1999 Form 1 - Application For, And Amendments To Application For, Registration As A National Securities Exchange Or Exemption From Registration - 1999 Legal
Form Ta-1 - Uniform Form For Registration As A Transfer Agent And For Amendment To Registration Pursuant To Section 17a Of The Securities Exchange Act Of 1934 Form Ta-1 - Uniform Form For Registration As A Transfer Agent And For Amendment To Registration Pursuant To Section 17a Of The Securities Exchange Act Of 1934 Legal
Form 9 - Application To Register By Qualification Securities Pursuant To Section 1707.09 Of The Revised Code Of Ohio - Ohio Dept. Of Commerce Form 9 - Application To Register By Qualification Securities Pursuant To Section 1707.09 Of The Revised Code Of Ohio - Ohio Dept. Of Commerce Financial
Form T-4 - Application For Exemption Filed Pursuant To Section 304(c) Of The Trust Indenture Act Of 1939 Form T-4 - Application For Exemption Filed Pursuant To Section 304(c) Of The Trust Indenture Act Of 1939 Legal

Related Categories

Parent category: Financial
Download
Go