Form 205 - Collector'S Annual Settlement

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Missouri Department of Revenue
Form
205
Collector’s Annual Settlement
Annual settlement of _________________________________ , collector of _______________________________________ county
for year ending February 28, 20 ___________ .
.
Amounts
Amounts
Total Collections
Total Current*
Total Delinquents
Total Back and Protested
Total Abatements
Total Other
Total Protested
Total Refunds
Total Credits
Total Charges
Tax Book Differences
Tax Book Differences
Grand Total Credits
Grand Total Charges
• Total Surtax in this Amount if not
Shown as a Separate Distribution
State
General Revenue
Special Road and Bridge
Health Center
Schools
Cities
Surtax
Assessment
Commissions: County
Official
Subtotal
Subtotal
Total Distributions
I, _________________________________ , clerk of the county commission of ______________________________________county
hereby certify the above and the attached to be a copy of the annual settlement of the county collector with the county commission on
the __________________________day of ________________________ , 20________ , for the year ending __________________ ,
20 ________ as the same appears of record in my office.
In testimony whereof, I have hereunto set my hand and affixed the seal of the county commission of ______________________
county. Done at my office in _______________________ this __________________________day of, ________________________
20 ________.
Clerk of County Commission
Form 205 (Revised 11-2013)

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