NOTICE
Please notify this office in writing if you are no longer in business or self-employed.
This information is necessary in order to terminate your account and eliminate 
subsequent court action. Notification can be mailed, emailed, or faxed.

          Gregory F. X. Daly
                                            Phone: (314) 622-3296
          Collector of Revenue
                                            Fax: (314) 622-4847
          1200 Market Street Room 410
                                            Email: earningstaxcor@stlouis-mo.gov
          Saint Louis MO 63103

YOUR NAME                                                      BUSINESS FEIN/SSN

NAME OF BUSINESS OR TYPE OF SELF EMPLOYMENT ADDRESS

DATE TERMINATED

REASON TERMINATED

I CERTIFY THAT THE ABOVE IS A TRUE AND ACCURATE STATEMENT

NOTE: IF  YOU OPERATED    SIGNED:                              TITLE:
FOR  ONLY  A  PART  OF  A 
YEAR,  A TAX RETURN  IS   PHONE NO:                      EMAIL:
STILL REQUIRED
                          DATE:
                                                                                Form E-5 (Rev. 11/21)