Form 53-V - Vendor'S Use Tax Return Page 2

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VENDOR’S USE TAX RETURN
PAGE
OF
MISSOURI TAX I.D. NUMBER
REPORTING PERIOD
OWNER’S NAME
BUSINESS NAME
ADJUSTMENTS
BUSINESS LOCATION
CODE
GROSS RECEIPTS
TAXABLE SALES
RATE (%)
AMOUNT OF TAX
(INDICATE + OR —)
PAGE
TOTALS . . . . . . . . . . . . . . . . .
FORM 53-V (01-2011)

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