Form 53-V - Vendor'S Use Tax Return
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3MISSOURI DEPARTMENT OF REVENUE
MISSOURI TAX I.D. NUMBER
FEDERAL I.D. NUMBER
TAXATION DIVISION
P.O. BOX 840
FORM
__ __ __ __ __ __ __ __
__ __ __ __ __ __ __ __ __
JEFFERSON CITY, MO 65105-0840
53-V
VENDOR’S USE
(573) 751-2836
• DO NOT WRITE IN SHADED AREAS
TAX RETURN
TDD (800) 735-2966
(REV. 01-2011)
Check box if Amended Return
Or Additional Return
OWNER’S NAME
REPORTING PERIOD
ADDRESS CORRECTION
MAILING ADDRESS
BUSINESS NAME
BUSINESS PHONE NUMBER:
(__ __ __) __ __ __ - __ __ __ __
MAILING ADDRESS
TELEPHONE NUMBER
(_ _ _) _ _ _ - _ _ _ _
DUE DATE:
CITY
STATE
ZIP
__ __ __ __ __
IMPORTANT:
THIS RETURN MUST BE FILED FOR THE REPORTING PERIOD INDICATED EVEN THOUGH YOU HAVE NO GROSS RECEIPTS/TAX TO REPORT.
ADJUSTMENTS
BUSINESS LOCATION
CODE
GROSS RECEIPTS
TAXABLE SALES
RATE (%)
AMOUNT OF TAX
(INDICATE + OR —)
PAGE 1 1 TOTALS . . . . . . . . . . . . . . . . .
PAGE
--
TOTALS . . . . . . . .
1.
TOTALS (ALL PAGES) . . . . . . . . . . . . .
Check our web site for the correct tax rate at If the rate
2.
SUBTRACT: 2% TIMELY PAYMENT
-
is more than 4.225%, local tax applies and you must add that higher rate to your return.
ALLOWANCE (if Applicable) . . . . . . . .
Instructions are updated annually and are provided on our web site at
3.
=
FINAL RETURN: If this is your final return, enter the close date below and check the reason for closing your account.
TOTAL VENDOR’S USE TAX DUE . .
Missouri law requires any person selling or discontinuing business to make a final sales tax return within fifteen
4.
ADD: INTEREST FOR LATE
(15) days of the sale or closing.
+
PAYMENT (See Line 4 of Instructions)
Date Business Closed: ___________________________
5.
Out of Business
Sold Business
Leased Business
+
ADD: ADDITIONS TO TAX . . . . . . . . .
SIGN AND DATE RETURN: This must be signed and dated by the taxpayer or by the taxpayer’s authorized agent.
6.
Mail to: Missouri Department of Revenue, P.O. Box 840, Jefferson City, MO 65105-0840.
-
SUBTRACT: APPROVED CREDIT . . .
I have direct control, supervision, or responsibility for filing this return and payment of the tax due. Under penalties of
7.
PAY THIS AMOUNT
perjury, I declare that this is a true, accurate, and complete return. I also declare under penalties of perjury
=
(U.S. Funds Only) . . . . . . . . . . . . . . .
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.
DOR USE ONLY
I ATTEST THAT I HAVE NO GROSS RECEIPTS TO REPORT FOR LOCATIONS LEFT BLANK.
SIGNATURE OF TAXPAYER OR AGENT
TITLE
DATE SIGNED
TAX PERIOD (MMDDYYYY) THRU (MMDDYYYY)
___ ___ / ___ ___ / ___ ___ ___ ___
__ __ / __ __ / __ __ __ __ THRU __ __ / __ __ / __ __ __ __
FORM 53-V (01-2011)
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