Detach this section at perforation and return.
Collector of Revenue                                                 EMPLOYER’S QUARTERLY EARNINGS TAX RETURN
City of St. Louis                                                               OF TAXES WITHHELD                                              W-10
1) NUMBER OF TAXABLE EMPLOYEES                                       QUARTER ENDING                                   DOLLARS                      CENTS
2) Total taxable earnings for quarter (See Instruction A if no wages were paid)                              2)
3) Tax withheld at 1% (.01) of line 2                                                                        3)
4) Less amount deposited in quarter if monthly deposits are required. (See Instruction B)                    4)
5) NET TAX DUE                                                                                               5)

6) Penalty (See Instruction E)                                                                               6)
7) Interest (See Instruction E)                                                                              7)
8) TOTAL DUE                                                                                                 8)
If  business  is  sold,  transferred  or  terminated  write  "Final" MAKE CHECKS PAYABLE TO: GREGORY F.X. DALY, COLLECTOR OF REVENUE
here              ,  and  follow  instructions  on  reverse  side.   MAIL TO: PAYROLL EXPENSE TAX DEPT., P.O. BOX 66966, ST. LOUIS, MO 63166-6966

                                                                                          FEIN:
                                                                                          I hereby certify that the statements herein are true.

                                                                                                             Signature
                                                                                          Title                                                Date
                                                                                          Business Telephone:

                                                     Detach this section at perforation and return.
Collector of Revenue                    PAYROLL EXPENSE TAX — QUARTERLY RETURN
City of St. Louis                                    QUARTER ENDING                                                                                P-10
1) NUMBER OF EMPLOYEES Subject to payroll expense tax this quarter:                                                   DOLLARS                      CENTS
2) Payroll within City of St. Louis for this quarter                                                         2) $
3) Tax Due – 1/2 of 1% (.005) of Line 2                                                                      3) $

4) Penalty (See Instructions)                                                                                4) $
5) Interest (See Instructions)                                                                               5) $
6) TOTAL DUE                                                                                                 6) $
If  business  is  sold,  transferred  or  terminated  write  "Final" MAKE CHECKS PAYABLE TO: GREGORY F.X. DALY, COLLECTOR OF REVENUE
here              ,  and  follow  instructions  on  reverse  side.   MAIL TO: PAYROLL EXPENSE TAX DEPT., P.O. BOX 66966, ST. LOUIS, MO 63166-6966

                                                                                          FEIN:
                                                                                          I hereby certify that the statements herein are true.

                                                                                                             Signature
                                                                                          Title                                                Date
                                                                                          Business Telephone:

                              Pursuant to the Revised Code of the City of St. Louis, § 5.22.100, the Collector of Revenue or his duly authorized agent has the
INSTRUCTIONS                  authority to audit facilities or tax returns of an employer or taxpayer subject to this section of the Tax Code.
EVERY  EMPLOYER  OR  NON-RESIDENT  EMPLOYER,  WHO  EMPLOYS  ONE  OR  MORE  PERSONS,  WORKING  OR  LIVING  IN  THE  CITY,  IS  REQUIRED  TO  WITH-
HOLD  ST.  LOUIS  CITY  EARNINGS  TAX  ON  GROSS  EARNINGS  FROM  THOSE  EMPLOYEES.  GROSS  EARNINGS  SHALL  INCLUDE,  BUT  IS  NOT  LIMITED  TO:
SALARIES,  WAGES,  COMMISSIONS,  FEES,  BONUSES,  EXTRA  LIFE  INSURANCE,  FELLOWSHIPS,  YEAR  END  PROFIT  SHARING,  RETIREMENT  INCENTIVE,
SEVERANCE PAY, TIPS OR OTHER COMPENSATION BASIS.
A — When No Wages Are Paid.   If you temporarily discontinue paying salaries, wages, etc., (for example seasonal activities), or if no salaries etc., were paid during the
quarter, you must nevertheless file a return. The return should be filed with the word "NONE" entered on line 2.
B  — To Receive  Credit  For  Monthly  Deposits. List  on  line  4  the  total  earnings  tax  withheld  and  previously  deposited  for  the  1st  and/or  2nd  month(s)  of  this
quarter. (this applies only to employers that withhold $1,500.00 or more earnings tax during either of the first 2 months of any quarter).
C — To File A "Final" Return. If a business is sold, transferred, or terminated you must file a "Final" return and so indicate in the space provided, on this return. If a business
is sold or transferred by one employer to another, each employer must file a separate return. The seller of the business must attach a statement showing the name and address
of the new owner, and the date of the sale or transfer. If a business is terminated you must notify this Office of the effective date of termination.

                                                                                                        D — Quarterly Returns and Due Dates
                                                                                                        Quarter ending:           DUE ON OR BEFORE:
                                                                                                        March 31                  April 30
                                                                                                        June 30                   July 31
                                                                                                        September 30              October 31
                                                                                                        December 31               January 31
E — Penalty and Interest. Failure to file and remit when due will result in a penalty of 5% of the amount of tax for each month or fraction thereof, to a maximum of 25%
until tax is paid. Interest will be 1% of the amount of tax, for each month or fraction thereof, from due date until tax is paid.
F — SIGN AND DATE RETURN      G — FOR INFORMATION, CALL (314) 622-4071 or visit our website at: www.stlouiscollector.com

                              Pursuant to the Revised Code of the City of St. Louis, § 5.22.100, the Collector of Revenue or his duly authorized agent has the
INSTRUCTIONS                  authority to audit facilities or tax returns of an employer or taxpayer subject to this section of the Tax Code.
EVERY  EMPLOYER,  RESIDENT  OR  NON-RESIDENT,  WHO  EMPLOYS  INDIVIDUALS  TO  PERFORM  WORK  OR  RENDER  SERVICE  WITHIN  THE  CITY  OF
ST.  LOUIS  IS  REQUIRED  TO  FILE  AND  PAY  PAYROLL  EXPENSE  TAX  ON  A  QUARTERLY  BASIS.  IF  YOU                           DID  NOT HAVE  ANY  PAYROLL  WITHIN
ST. LOUIS DURING THE QUARTER, YOU MUST FILE A RETURN WITH THE WORD "NONE" ENTERED ON LINE 2.
A. On Line 1: Enter number of employees subject to the tax.
B. On Line 2: Enter payroll for the quarter within City of St. Louis.
C. On Line 3: Payroll Expense Tax — 1/2 of 1% (.005) of Line 2.
D. On Line 4: Penalty  —  Failure  to  file  and  remit  when  due  will  result  in  a  penalty  of  5%  of  the  amount  of  tax  for  each  month  or  fraction  thereof,  to  a  maximum
              of 25% until tax is paid.
E. On Line 5: Interest  — In  addition  to  penalty,  there  will  be  interest  of  1%  of  the  amount  of  tax  for  each  month  or  fraction  thereof  from  the  due  date  until
              tax is paid.
F. On Line 6: Total due (including penalty and interest, if applicable).
                                                 G. TO FILE A "FINAL" RETURN
                                                           If a business is sold, transferred or terminated you must file a      "Final"  return, and so indicate in the space
                                                           provided  on  this  return.  If  the  business  is  sold  or  transferred  by  one  employer  to  another,  each  employer
                                                           must  file  a  separate  return.  The  seller  of  the  business  must  attach  a  statement  showing  the  name  and
                                                           address of the new owner, and the date of the sale or transfer. If a business is terminated you must notify this
                                                           office of the effective date of termination. A final return will be verified by this office.
                                                 H. QUARTERLY RETURN DUE DATES
                                                                     Quarter Ending:                             Due on or Before:
                                                                        March 31                                        April 30
                                                                        June 30                                         July 31
                                                                        September 30                                    October 31
                                                                        December 31                                     January 31
                                                 I. SIGN AND DATE RETURN                                J. FOR INFORMATION, CALL (314) 622-4071 or visit
                                                                                                        our website at: www.stlouiscollector.com