(1) Daytime Telephone Number:
    Form E-6            NOT - FOR - PROFIT ORGANIZATIONS
COLLECTOR OF REVENUE    INFORMATIONAL DISBURSEMENT REPORT                                                                  (2) FEIN or SSN:
    CITY OF ST. LOUIS
    (Rev 11/21)                                      CALENDAR YEAR 2021
                                                     PAYMENT CODES FOR INFORMATIONAL REPORT                                (3) Email Address:
                                                     NOTE: You must assign a code number to the payments reported.
                                                  1. Sub or Independent Contractor  2. Professional Fee  3. Director’s Fee
                                               4. Management Fee  5. Consulting Fee  6. Equipment Leasing  7. Entertainment
                                                                  8. Commission/Bonus  9. Legal Fees          Return this form on or before  Date:
                                                                                                              March 1, 2022 to:
    PLEASE PRINT YOUR NAME AND ADDRESS IN THE SPACE BELOW                                                     Gregory F.X. Daly              Audited By:
                                                                                                              Collector of Revenue
                        (IF NOT ALREADY PROVIDED)                                                             1200 Market Street, Room 410
                                                                                                              St. Louis, MO 63103-2841
                                                                                                              OFFICE USE ONLY

(A)             TO WHOM PAID                                      (B)                     (C)                 (D)                 (E)       Amount or OFFICE USE
                                                                      FEIN/SSN            Code Number         Total Amount Paid       Percent Earned
    Name        Address                        City, State, Zip                                                                       Within the City   ONLY

(Please attach additional sheets as necessary.)

                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 authority to audit the facilities or tax returns of an employer or taxpayer. I declare this return has been examined
                by me and is true, correct and complete to the best of my knowledge and belief.

    (Date)                                     (Signature)                                (Typed or Printed Name)                           (Title)

     IMPORTANT INFORMATION

This form must be completed when the following deductions are claimed: sub or independent contracting, 
professional fees, director’s fees, management fees, consulting fees, equipment leasing, entertainment, 
commissions or bonuses, or legal fees. Please report only resident businesses or individuals of the City of 
St. Louis, or non-resident businesses or individuals that performed work in the City, and received payments 
totaling more than $1,000.00 in the calendar year. All payments made to booking agents, promoters, and 
entertainers must be reported as “Entertainment”. If no such payments were made during the calendar year, 
please indicate “N/A” on the form and return to this office.

Please do not report basic business expenses, such as utilities, supplies, etc.,W-2 wages or salaries on this 
form.

     INSTRUCTIONS

1.  Please complete boxes 1, 2 and 3. Indicate the telephone number and email address where you can be 
reached between 8:00 a.m. and 5:00 p.m CST.
2. In column A, please complete the name and address section indicating to whom payment was made. In 
column B, print the Federal Employer Identification Number or the Social Security Number to each 
payee. In column C, print the code number which best describes the payment. In column D, print the 
total amount paid. In column E, print the amount or percent of worked performed within the City.
3. You may elect to include copies of Forms 1099-MISC and 1099-NEC that you have issued. Please 
note on each form the code number and amount applicable to the City. Please list all corporations not 
issued a Form 1099-MISC or 1099-NEC.
4.  Please date, sign, and print your name in the spaces provided.
5.  Only complete and legible returns will be processed.
6.  Forms and doumentation should be mailed, faxed or emailed on or before March 1, 2022 to:

     GREGORY F.X. DALY
     COLLECTOR OF REVENUE
     1200 MARKET STREET, ROOM 410
     ST. LOUIS, MO 63103-2841

     Telephone: (314) 622-3296
     Fax: (314) 622-4847
     Email: earningstaxcor@stlouis-mo.gov

     WEBSITE: www.stlouiscollector.com