Form 1315f - Monthly Statement Of Collections
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1
2Missouri Department of Revenue
Form
Monthly Statement of Collections
1315A
Use this form to certify monthly collections to the Director of Revenue. If collector fails to file his or her monthly
statements with the county clerk, the county clerk should notify the Director of Revenue and the Prosecuting Attorney.
Name (Clerk of the County Commission)
County
Month
Year
The aforementioned clerk hereby certifies to the Director of Revenue, that from the monthly statement filed in their office, that they have
collected for state purposes the following amounts:
Gross collections must be reported in all cases.
Interest
Total
Tax
Land Tax, 2014
$
$
$
Personal Tax, 2014
License Collection
Utility
Railroad
Payment in Lieu of Taxes
Protest
Sur Tax
Total Current Collections
Tax
Interest
Total
Land, 2013
$
$
$
Land, 2012
Land, 2011
Land, 2010
Land, 2009
Land, 2008
Total Back Land
Tax
Interest
Total
Personal, 2013
$
$
$
Personal, 2012
Personal, 2011
Personal, 2010
Personal, 2009
Personal, 2008
Total Back Personal
Tax
Interest
Total
$
$
$
Total Back Tax Collections
Grand Total Collections
$
$
$
Witness my hand and official seal
Done at my Office in
, Missouri
This
Day of
20
Clerk of the County Commission
— Department of Revenue, — County Courthouse
Form 1315A (Revised 11-2013)
Mail to:
Taxation Division
Phone: (573) 751-5900
Visit
dor.mo.gov/business/citycounty/
P.O. Box 453
TDD: 1-800-735-2966
for additional information.
Jefferson City, MO 65105-0453
Fax: (573) 522-1160
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Parent category: Financial