MISSOURI TAX I.D. NUMBER
FEDERAL I.D. NUMBER
MISSOURI DEPARTMENT OF REVENUE
RETE
FORM
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TAXATION DIVISION
53U-1
P.O. BOX 840
• DO NOT WRITE IN SHADED AREAS
JEFFERSON CITY, MO 65105-0840
(573) 751-2836
(REV. 06-2010)
USE TAX RETURN
TDD (800) 735-2966
Check box if Amended Return
Or Additional Return
OWNER’S NAME
REPORTING PERIOD
ADDRESS CORRECTION
MAILING ADDRESS
REPORTING LOCATION
BUSINESS NAME
Check here if
BUSINESS PHONE NUMBER:
phone # changed
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MAILING ADDRESS
PHONE NUMBER
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DUE DATE:
CITY
STATE
ZIP
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VENDOR’S USE TAX
ADJUSTMENTS
GROSS RECEIPTS
TAXABLE SALES
RATE (%)
AMOUNT OF TAX
(INDICATE + OR —)
1.
VENDOR’S TOTALS (ALL PAGES) . . . . . . . . . . . .
If there are no Vendor’s Sales or Consumer’s Taxable
2.
SUBTRACT: 2% TIMELY PAYMENT ALLOWANCE (IF APPLICABLE) . . . . . . . . . . . . . .
Purchases for a specified location, enter zero (0). If the
–
location is left blank, this will be recognized as zero (0) Sales
3.
and/or Taxable Purchases.
VENDOR’S USE TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
=
CONSUMER’S USE TAX
LOCATION
CODE
TAXABLE PURCHASES
RATE (%)
AMOUNT OF TAX
4.
PAGE 1 CONSUMER’S TOTALS . . . . . . . . . . . . . .
5.
PAGES 2-
CONSUMER’S TOTALS . . . . . . . . . . .
6.
CONSUMER’S TOTALS (ALL PAGES) . . . . . . . . . .
+
I do not have cumulative taxable purchases totaling more than $2,000 this calendar year and do not owe Consumer’s Use Tax at this time.
TOTAL OF VENDOR’S GROSS RECEIPTS AND CONSUMER’S TAXABLE PURCHASES . .
7.
Instructions are updated annually and are provided on our web site at
8.
=
TOTAL USE TAX DUE . . . . . . . . . . . . . .
FINAL RETURN: If this is your final return, enter the close date below and check the reason for closing your account.
9.
ADD: INTEREST FOR LATE
Missouri law requires any person selling or discontinuing business to make a final use tax return within fifteen
+
PAYMENT (See Line 9 of Instructions) . .
(15) days of the sale or closing.
Date Business Closed: ___________________________
10.
ADD: ADDITIONS TO TAX
Out of Business
Sold Business
Leased Business
(See Instructions) . . . . . . . . . . . . . . . . . ..
+
If you pay by check, you authorize the Department of Revenue to process the check electronically.
Any check returned unpaid may be presented again electronically.
11.
SUBTRACT: APPROVED CREDIT . . . . .
–
SIGN AND DATE RETURN: This must be signed and dated by the taxpayer or by the taxpayer’s authorized agent.
Mail to: Missouri Department of Revenue, P.O. Box 840, Jefferson City, MO 65105-0840.
12.
PAY THIS AMOUNT . . . . . . . . . . . . .
=
I have direct control, supervision, or responsibility for filing this return and payment of the tax due. Under penalties of
perjury, I declare that this is a true, accurate, and complete return.
I ATTEST THAT I HAVE NO GROSS RECEIPTS TO REPORT FOR LOCATIONS LEFT BLANK.
I also 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.
SIGNATURE OF TAXPAYER OR AGENT
TITLE
TAX PERIOD (MMDDYYYY) THRU (MMDDYYYY) DATE SIGNED
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MO 860-1124 (06-2010)