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

GREGORY F.X. DALY
COLLECTOR OF REVENUE
410 CITY HALL
1200 MARKET STREET
SAINT LOUIS, MISSOURI 63103-2841                            SEE REVERSE SIDE...
TELEPHONE: (314) 622-4248
FAX: (314) 622-4847

YOUR NAME:                                                  BUSINESS FID/SS #

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 FOR                    SIGNED:
                                                                             Title:
ONLY PART OF A YEAR, A TAX
RETURN IS STILL REQUIRED.                    DATE:          PHONE NO:
                                                                             Form E-5 (Rev. 11/08)